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General information

Name: nl.zorg.FreedomRestrictingMeasures NL.png
Version: 3.2
HCIM Status:Final
Release: 2019
Release status: Prepublished
Release date: 06-07-2019

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DCM::CoderList Werkgroep RadB Verpleegkundige Gegevens
DCM::ContactInformation.Address *
DCM::ContactInformation.Name *
DCM::ContactInformation.Telecom *
DCM::ContentAuthorList Werkgroep RadB Verpleegkundige Gegevens
DCM::CreationDate 5-5-2014
DCM::DescriptionLanguage nl
DCM::EndorsingAuthority.Name PM
DCM::Id 2.16.840.1.113883.
DCM::KeywordList Vrijheidsbeperkendemaatregelen, wilsbekwaamheid, interventies
DCM::LifecycleStatus Final
DCM::ModelerList Werkgroep RadB Verpleegkundige Gegevens
DCM::Name nl.zorg.VrijheidsbeperkendeMaatregelen
DCM::PublicationDate 06-07-2019
DCM::PublicationStatus Prepublished
DCM::ReviewerList Projectgroep RadB Verpleegkundige Gegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate 24-4-2018
DCM::Superseeds nl.zorg.VrijheidsbeperkendeMaatregelen-v3.1.1
DCM::Version 3.2
HCIM::PublicationLanguage EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (01-07-2015)

Publicatieversie 3.0 (01-05-2016)

Publicatieversie 3.1 (04-09-2017)

ZIB-530 Verwijzingen naar de bouwsteen Verpleegkundige Interventie verwijderd

Publicatieversie 3.1.1 (01-10-2018)

ZIB-732 Een aantal Snomed codes blijken bij nadere controle invalide. Een aantal andere codes zijn inmiddels Inactive verklaard in SNOMED

Publicatieversie 3.2 (26-02-2019)

ZIB-670 Graag afzonderlijke zib maken van data element juridische status


Freedom restricting measures are (physical or verbal) measures used to deliberately restrict the freedom of the patient in question.
Many forms of freedom restricting measures fall under this definition, including but not limited to:

  • involuntary treatment (e.g. forced medication)
  • physical restraints (side rails fully up)
  • physical fixation (arm restraints in order to prevent removal of drip)
  • electronic surveillance to monitor the whereabouts of the patient.

In hospitals, these often include the use of side rails, a cushion belt (around the waist) or a Posey bed. Often sedatives are administered in combination with the freedom restricting measures. For small children it often involves fixation of e.g. hands to prevent the extraction of a nasogastric tube.
The Vereniging Verpleegkundigen & Verzorgenden Nederland (V&VN) [Dutch Nurses and Carers Association] published a set of guidelines for nurses to implement these restraints in hospitals.
The ‘Wet BOPZ’ [Dutch Psychiatric Hospitals (Compulsory Admissions) Act] protects the rights of clients who are involuntarily admitted into mental healthcare, services for the disabled and in geriatric psychiatry. The act only applies to ‘BOPZ’-marked facilities and also applies to some (closed) wards in nursing homes. Mental healthcare facilities use a national registration system to register the restraints called Argus registration.
Permission of the patient or his/hers legal representative is required before starting freedom restricting measures.
The patient’s high-risk behavior providing cause for the restraints is not described in this concept.


Implementing medical restraints is risky and can result in damage to the patient if they are not carefully implemented. Nurses fulfil an important role in identifying risks, observing the effect of the restraints and any changes to the policy in terms of medical restraints. Recording all information on the measures is of major importance for insight into decision-making, implementing, monitoring and evaluating the measures. In the event of a transfer to the next facility, the proper preparations can be taken to safely continue the care and to limit the risks to the patient and their environment.

Information Model


Type Id Concept Card. Definition DefinitionCode Reference
Block.png NL-CM:14.3.1 Arrowdown.pngFreedomRestrictingMeasures Root concept of the FreedomRestrictingMeasures information model. This root concept contains all data elements of the FreedomRestrictingMeasures information model.
BL.png NL-CM:14.3.3 Arrowright.pngLegallyCapable 1 Indicator stating whether the patient is deemed capable of overseeing the consequences of a certain procedure, situation or decision.
ST.png NL-CM:14.3.4 Arrowright.pngLegallyCapableComment 0..1 Comment on the decisions which the patient is legally capable of making.
48767-8 Annotation comment [Interpretation] Narrative
Verwijzing.png NL-CM:14.3.10 Arrowright.pngLegalSituation 0..1 The legal situation that applies to the patient during the intervention.
Block.png LegalSituation
Folder.png NL-CM:14.3.5 Arrowdown.pngIntervention 0..* Container of the Restraint concept. This container contains all data elements of the Restraint concept.
CD.png NL-CM:14.3.6 Arrowright.pngTypeOfIntervention 1 The type of restraint describes the medical restraints.
225317005 Restriction of movement
List2.png ArgusTypeOfInterventionCodelist
List2.png TypeOfInterventionCodelist
CD.png NL-CM:14.3.7 Arrowright.pngPermission 1 The permission given to the health professional(s) by the patient or legal representative to implement the medical restraint.
309370004 Consent status
List2.png ArgusPermissionCodelist
List2.png PermissionCodelist
TS.png NL-CM:14.3.8 Arrowright.pngStartEpisode 0..1 The date and time at which the restraints started.
TS.png NL-CM:14.3.9 Arrowright.pngEndOfEpisode 0..1 The date and time at which the restraints ended.

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page List2.png

Example Instances

Only available in Dutch

Wilsbekwaam Nee
WilsbekwaamToelichting Wilsonbekwaam t.a.v. geldzaken.
SoortInterventie Links armspalk i.v.m. infuus.
Toestemming Instemming wettelijke vertegenwoordiger
AanvangEpisode 01-05-2014
EindeEpisode 05-05-2014


Mental healthcare uses a national registration system (Argus registration) when implementing medical restraints. In this context the codelists ArgusInterventieCodelijst and ArgusInstemmingCodelijs are applicable. In all other cases the codelists SoortInterventieCodelijst en ToestemmingCodelijst shall be used


1. Handreiking Argus [Online] Beschikbaar op: [Geraadpleegd: 13 februari 2015] 2. Argus [Online] Beschikbaar op: [Geraadpleegd: 13 februari 2015] 3. Handreiking "Vrijheidsbeperking in het ziekenhuis? Nee, tenzij…" (V&VN, 2013) [Online] Beschikbaar op: [Geraadpleegd: 13 februari 2015]



Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Op eigen verzoek E1 ArgusCodes 2.16.840.1.113883. Op eigen verzoek
Geen verzet E2 ArgusCodes 2.16.840.1.113883. Geen verzet
Verzet E3 ArgusCodes 2.16.840.1.113883. Verzet


Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Separatie A1 ArgusCodes 2.16.840.1.113883. Separatie
Afzondering A2 ArgusCodes 2.16.840.1.113883. Afzondering
Fixatie A3 ArgusCodes 2.16.840.1.113883. Fixatie
Gedwongen medicatie A4 ArgusCodes 2.16.840.1.113883. Gedwongen medicatie
Gedwongen voeding en/of vocht A5 ArgusCodes 2.16.840.1.113883. Gedwongen voeding en/of vocht
Andere interventies A6 ArgusCodes 2.16.840.1.113883. Andere interventies


Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Geen instemming patiënt 1 InstemmingStatus 2.16.840.1.113883. Geen instemming patiënt
Instemming patiënt 2 InstemmingStatus 2.16.840.1.113883. Instemming patiënt
Geen instemming wettelijk vertegenwoordiger 3 InstemmingStatus 2.16.840.1.113883. Geen instemming wettelijk vertegenwoordiger
Instemming wettelijke vertegenwoordiger 4 InstemmingStatus 2.16.840.1.113883. Instemming wettelijke vertegenwoordiger


Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Secluding patient 90278001 SNOMED CT 2.16.840.1.113883.6.96 Separatie
Segregation of patient 29251000146109 SNOMED CT 2.16.840.1.113883.6.96 Afzondering
Physical restraint 386423001 SNOMED CT 2.16.840.1.113883.6.96 Fixatie
Forced medication 29211000146105 SNOMED CT 2.16.840.1.113883.6.96 Gedwongen medicatie
Forced feeding of patient 37041007 SNOMED CT 2.16.840.1.113883.6.96 Gedwongen voeding en/of vocht
Other OTH NullFlavor 2.16.840.1.113883.5.1008 Anders

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Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

  • HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment Artdecor.jpg
  • HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR Fhir.png


This information model is also available as pdf file PDF.png or as spreadsheet Xlsx.png

About this information

The information in this wikipage is based on Prerelease 2019-1
SNOMED CT and LOINC codes are based on:

  • SNOMED Clinical Terms version: 20190131 [R] (January 2019 Release)
  • LOINC version 2.64

Conditions for use are located on the mainpage List2.png
This page is generated on 07/07/2019 11:31:56 with ZibExtraction v. 3.0.7127.3724

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