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General information

Name: nl.zorg.TreatmentDirective2 NL.png
Version: 2.0
HCIM Status:Final
Release: 2022
Release status: Prepublished
Release date: 10-06-2022

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DCM::CoderList Kerngroep Registratie aan de Bron
DCM::ContactInformation.Address *
DCM::ContactInformation.Name *
DCM::ContactInformation.Telecom *
DCM::ContentAuthorList Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::CreationDate 17-8-2020
DCM::DescriptionLanguage nl
DCM::EndorsingAuthority.Name PM
DCM::Id 2.16.840.1.113883.
DCM::KeywordList advance directives, behandel aanwijzing, wilsverklaring, behandelbeperking
DCM::LifecycleStatus Final
DCM::ModelerList Kerngroep Registratie aan de Bron
DCM::Name nl.zorg.BehandelAanwijzing2
DCM::PublicationDate 10-06-2022
DCM::PublicationStatus Prepublished
DCM::ReviewerList Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate 09-05-2022
DCM::Supersedes nl.zorg.BehandelAanwijzing2-v1.0
DCM::Version 2.0
HCIM::PublicationLanguage EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (01-09-2020) Vervangt zib BehandelAanwijzing

Publicatieversie 2.0 (10-06-2022)

ZIB-1126 Behandelaanwijzing code voor reanimatie
ZIB-1562 Wijzingsverzoek behandelaanwijzing
ZIB-1592 Tekstuele wijzigingen zib BehandelAanwijzing2 (2020)


A treatment directive contains a joint decision between a health professional (for example a general practitioner) and a patient or his representative(s) about the desirability of performing a certain treatment, such as resuscitation, before this treatment becomes (acute) necessary.
When the need arises and the treatment cannot be discussed with the patient or representative (s), that decision is an important indication for the treating health professional (for example an ER doctor).
The term treatment limit is a synonym of the term treatment directive.


A good overview of treatment instructions based on the wishes of the patient or their authorized representative on (un)desired treatments is important in a patient’s care. A concise, orderly list is of particular importance in acute care situations. Due to the large variety of symptoms, the situation concerns not only a CPR setting, but also cases in which the patient’s condition rapidly worsens as a result of existing symptoms.
A healthcare provider consulting this information can discuss these existing treatment instructions with the patient, the patient’s family or the patient’s authorized representative and possibly include the instructions in their policy.

Evidence Base

Explanation for TreatmentCodeList:
In discussions on constraints in the therapeutic treatment of patients with a chronic neurological or respiratory condition, respiration is sometimes included as a separate restriction. The ‘Respiration’ item is to be seen separately from the decisions on CPR.

Information Model


Type Id Concept Card. Definition DefinitionCode Reference
Block.png NL-CM:2.2.1 Arrowdown.pngTreatmentDirective Root concept of the TreatmentDirective2 information model. This concept contains all data elements of the TreatmentDirective2 information model.
129125009 Procedure with explicit context
CD.png NL-CM:2.2.2 Arrowright.pngTreatmentDecision 1 The joint decision taken with regard to the desirability of performing the indicated treatment.

If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment.

List2.png TreatmentDecisionCodelist
CD.png NL-CM:2.2.3 Arrowright.pngTreatment 1 The medical treatment to which the treatment instruction applies.
363589002 Associated procedure
List2.png TreatmentCodelist
ST.png NL-CM:2.2.4 Arrowright.pngSpecificationOther 0..1 Specification of the treatment decision when the decision is 'Other'.
TS.png NL-CM:2.2.5 Arrowright.pngMostRecentReviewDate 1 The date on which the treatment directive has been agreed with the patient and / or his representative (s). This can be the first time that the treatment directive has been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same.
TS.png NL-CM:2.2.6 Arrowright.pngDateExpired 0..1 The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care provider and the patient or his representative(s).

Any future termination can only be entered as a condition. Often this will be linked to 1 or more events.

ST.png NL-CM:2.2.7 Arrowright.pngReasonForEnding 0..1 Reason why the agreement on a treatment directive no longer applies.
Verwijzing.png NL-CM:2.2.8 Arrowright.pngAdvanceDirective 0..* A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.
713603004 Advance care planning
Block.png AdvanceDirective
Folder.png NL-CM:2.2.9 Arrowdown.pngAgreementParty 2..* Container of the AgreementParty concept. This container contains all data elements of the AgreementParty concept.
408730004 Procedure context
Verwijzing.png NL-CM:2.2.10 Arrowright.pngPatient (0..1) Patient as the person with whom the agreement was made.
Block.png Patient
Verwijzing.png NL-CM:2.2.11 Arrowright.pngRepresentative::ContactPerson (0..1) Person who represents the patient in health care matters and with whom the agreement has been made (too).
Block.png ContactPerson
Verwijzing.png NL-CM:2.2.12 Arrowright.pngHealthProfessional (0..1) HealthProfessional who has made the agreement regarding the treatement directive.
Block.png HealthProfessional
ST.png NL-CM:2.2.13 Arrowright.pngComment 0..1 The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc.
48767-8 Annotation comment [Interpretation] Narrative

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

Behandeling Behandeling Besluit SpecificatieAnders AfspraakPartij Recentste
Bespreek Datum
Opname op Intensive Care Wel uitvoeren H.J. Jansen 11-9-2012
Behandeling Behandeling Besluit SpecificatieAnders AfspraakPartij Recentste
Bespreek Datum
Cardiopulmonaire resuscitatie Anders eerst overleg met echtgenote D. de Jong 11-9-2012



Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Admission to intensive care unit 305351004 SNOMED CT 2.16.840.1.113883.6.96 Opname op intensive care
Resuscitation 439569004 SNOMED CT 2.16.840.1.113883.6.96 Reanimatie
Cardiopulmonary resuscitation 89666000 SNOMED CT 2.16.840.1.113883.6.96 Cardiopulmonaire resuscitatie [DEPRECATED]
Artificial respiration 40617009 SNOMED CT 2.16.840.1.113883.6.96 Kunstmatige beademing
Administration of blood product 116762002 SNOMED CT 2.16.840.1.113883.6.96 Toediening van een bloedproduct
Antibiotic therapy 281789004 SNOMED CT 2.16.840.1.113883.6.96 Toediening van antibiotica
Hospital admission 32485007 SNOMED CT 2.16.840.1.113883.6.96 Opname in ziekenhuis
Renal dialysis 265764009 SNOMED CT 2.16.840.1.113883.6.96 Nierdialyse
Tube feeding of patient 61420007 SNOMED CT 2.16.840.1.113883.6.96 Sondevoeding
Surgical procedure 387713003 SNOMED CT 2.16.840.1.113883.6.96 Operatie
Endotracheal respiratory assistance 182686001 SNOMED CT 2.16.840.1.113883.6.96 Endotracheale ademhalingsondersteuning
Noninvasive ventilation 428311008 SNOMED CT 2.16.840.1.113883.6.96 Non invasieve beademing
Therapeutic procedure 277132007 SNOMED CT 2.16.840.1.113883.6.96 Therapeutische verrichting
Admission to cardiac intensive care unit 183446009 SNOMED CT 2.16.840.1.113883.6.96 Opname op CCU
Other OTH NullFlavor 2.16.840.1.113883.5.1008 Overige behandelingen


Valueset OID: 2.16.840.1.113883. Binding: Required
Conceptname Conceptcode Codesystem name Codesystem OID Description
Do perform 0 BehandelBesluiten 2.16.840.1.113883. Wel uitvoeren
Other 1 BehandelBesluiten 2.16.840.1.113883. Anders
Do not perform 2 BehandelBesluiten 2.16.840.1.113883. Niet uitvoeren

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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:

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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 Pre-release 2022-1
SNOMED CT and LOINC codes are based on:

  • SNOMED Clinical Terms version: 20220131 [R] (January 2022 Release)
  • LOINC version 2.67

Conditions for use are located on the mainpage List2.png
This page is generated on 10/06/2022 12:39:26 with ZibExtraction v. 8.0.8196.20371

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