German Dental FHIR Profiles (R4)
0.36.1 - trial-use
DE
German Dental FHIR Profiles (R4) - Local Development build (v0.36.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
This document records the architecture decision and rationale for which dental profiles
have been migrated to use Praxis*DE parent profiles and which remain on raw FHIR R4 base resources.
The 3-Layer-Chain pattern is: KBV → praxis-de → dental-de (or, for resources without KBV base, FHIR R4 → praxis-de → dental-de).
kbv.basis or raw FHIR R4) — German GKV / German base constraintsPraxis*DE / *PraxisDe wrapper profiles (de.cognovis.fhir.praxis) — shared practice-level constraints reusable across cognovis IGsDental*DE profiles (this IG) — dental-domain specific constraints| Dental Profile | New Parent | Replaces | Bead | Released |
|---|---|---|---|---|
DentalConditionDE |
PraxisConditionDE |
Condition (raw FHIR R4) |
fdde-pax.2 | v0.31.0 |
DentalOrganizationDE |
PraxisOrganizationDE |
Organization (raw FHIR R4) |
fdde-pax.2 | v0.31.0 |
BemaChargeItemDE |
ChargeItemPraxisDe |
ChargeItem (raw FHIR R4) |
fdde-n4q | v0.32.0 |
GozChargeItemDE |
ChargeItemPraxisDe |
ChargeItem (raw FHIR R4) |
fdde-n4q | v0.32.0 |
| Dental Profile | Parent | Purpose | Bead | Released |
|---|---|---|---|---|
GozZahntechWerkstueckChargeItemDE |
GozChargeItemDE |
Eigenlabor-Werkstücke 7 % USt (Anlage 2 Nr. 52 UStG) | fdde-8vf | v0.34.0 |
The classifications below are correct against de.cognovis.fhir.praxis@0.69.1.
Dental adopts the same Account-centered billing-case model as fhir-praxis-de (ADR-039 / fpde-cj3):
| Concern | Dental model | Notes |
|---|---|---|
| Clinical contact | DentalEncounterDE (parents Encounter directly) |
Billing-agnostic: class AMB/HH only; no Scheintyp, coverage, or Abrechnungsquartal on Encounter |
| Billing case (Schein) | Reuse AccountPraxisSchein from de.cognovis.fhir.praxis |
No AccountDentalSchein — identical shape (ScheinNummer, Scheinart gkv/pkv, servicePeriod, coverage, active/inactive) |
| Encounter → Account | DentalEncounterDE.account → AccountPraxisSchein |
Must-support |
| ChargeItem → Account | BemaChargeItemDE.account / GozChargeItemDE.account → AccountPraxisSchein |
1..1 must-support |
| Abrechnungsstatus | DentalClaimDE.status / ClaimResponse |
Not Account.status (only open/closed Schein) |
| Gebührenordnung (BEMA/GOZ/KZBV) | ChargeItem code system + Claim lines | Distinct from Account.type (Versicherungs-/Scheinart gkv/pkv) |
| AW-SST export | DentalEncounterDE → KBV_PR_AW_Begegnung crosswalk |
Account has no AW equivalent; decomposes on export (same as praxis aw-sst-crosswalk.md) |
| Dental Profile | Available Praxis Wrapper | Why deferred / what to evaluate |
|---|---|---|
DentalEncounterDE |
EncounterPraxis |
Not adopted as parent (fdde-gzsq): dental profile mirrors the same ADR-039 contact semantics on base Encounter + AccountPraxisSchein reference; avoids inheriting praxis-only extensions (e.g. Wegegeld) until needed. |
DentalCarePlanDE |
PraxisCarePlanDE (← CarePlan) |
praxis wrapper exists but its constraint shape was not designed against dental HKP/KFO/PAR plans; needs a fit analysis before adopting as parent. |
DentalImagingStudyDE |
ImagingStudyPraxisDe (← ImagingStudy-uv-ips) |
Inherits IPS (International Patient Summary) constraints which add cardinality/binding requirements potentially incompatible with dental Intraoral/OPG/DVT modeling. Needs careful diff before migrating. |
DentalImagingDiagnosticReportDE |
ImagingDiagnosticReportPraxisDe (← imr-diagnosticreport) |
praxis wrapper slices category into roentgen/CT/MRT — dental radiology mostly aligns with the roentgen slice; viable migration candidate. |
DentalCbctImagingStudyDE |
(inherits from DentalImagingStudyDE) |
Sub-profile of DentalImagingStudyDE; migrates transitively when its parent migrates. |
| Dental Profile | Available Praxis Wrapper | Why NOT a migration candidate |
|---|---|---|
DentalCommunicationDE |
PraxisCommunication (← Communication) |
praxis wrapper targets internal practice-to-practice messaging, not the dental referral / lab order use case. Inheritance would import constraints that don't fit. |
DentalFindingDE |
PraxisLabObservation (← Observation) |
praxis wrapper is specifically for lab Observations (LOINC-bound, lab category). Dental Zahnschema/FDI findings are a different Observation semantic — inheritance would force incorrect category. |
DentalLabServiceRequestDE |
ImagingServiceRequestPraxisDe (← imr-servicerequest) |
praxis wrapper is for imaging service requests. Dental lab orders (ZTL) are a different domain — no fit. |
DentalProcedureDE |
ProcedureAmbulantDE (← Procedure, OPS-coded) or RoentgenProcedurePraxisDe (← Procedure-uv-ips) |
praxis wrappers are OPS-coded (medical) or radiology-specific (Roentgen). Dental procedures use BEMA/GOZ coding — no parent-fit. |
| Dental Profile | Base Resource | Status |
|---|---|---|
DentalClinicalImpressionDE |
ClinicalImpression |
No PraxisClinicalImpressionDE in praxis@0.64.0. |
DentalAtfBundleDE |
Bundle |
No PraxisBundleDE (and not appropriate — ATF MessageBundle structure is specified by de.gematik.fhir.atf). |
OralHealthScreeningDE |
Observation |
No generic PraxisObservationDE wrapper (only PraxisLabObservation, which is lab-specific). |
PeriodontalObservationDE |
Observation |
Same as above. |
ProphylaxisObservationDE |
Observation |
Same as above. |
Re-evaluate this table whenever de.cognovis.fhir.praxis publishes a new minor version.
Each new Praxis*DE wrapper potentially unlocks a 3-Layer-Chain migration for the
corresponding Dental*DE profile — file a migration bead if the new parent is a structural fit.
Since v0.32.0, both BemaChargeItemDE and GozChargeItemDE inherit from
ChargeItemPraxisDe, which makes the praxis-de tax extensions available via inheritance:
TaxCategoryExt (UN/CEFACT 5305 codes: S=19% / AA=7% / E=steuerfrei / AE=Reverse-Charge / Z=Nullsatz)TaxExemptionReasonExt (CodeSystem ust-befreiungsgrund: para4-nr14a, para4-nr14b, para4-nr16, para4-nr17a, para4-nr23, kleinunternehmer-para19)Since v0.34.0 the concrete tax-pattern is implemented via fdde-8vf:
BemaChargeItemDE fixes both extensions to E + para4-nr14a (BEMA = ausnahmslos GKV-Heilbehandlung)GozChargeItemDE carries both as MS with two invariants goz-tax-iff-e (Befreiungsgrund iff E) and goz-tax-verlangens-s (Verlangens → S)GozZahntechWerkstueckChargeItemDE fixes TaxCategory=AA for Eigenlabor-WerkstückeSee ust-modellierung.md for the full design.
fdde-pax.2 — DentalConditionDE + DentalOrganizationDE migration (v0.31.0)fdde-n4q — BemaChargeItemDE + GozChargeItemDE migration (v0.32.0)fdde-8vf — USt-Modellierung in dental ChargeItems (depends on fdde-n4q)sushi-config.yaml — dependency de.cognovis.fhir.praxis: 0.69.1fdde-gzsq — ADR-039 Account model: DentalEncounterDE contact + AccountPraxisSchein reuse + DentalClaimDE boundary profile