Confirmation

A person who receives medical psychological paramedical or nursing care. In some care settings the term client or participant is used instead of the term patient. Nationality is used as an indication of the country of citizenship. Marital status is a person’s formal position as defined by the Dutch civil code. There is a distinction between marriage and civil union. Linguistic proficiency is the ability to express oneself in a certain language and understand statements made in that language. This includes both oral and written communication.

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.

The blood pressure is a parameter for determining the condition of the blood circulation and is expressed in systolic and diastolic pressure in mmHg.

A contact is any interaction regardless of the situation between a patient and the healthcare provider in which the healthcare provider has primary responsibility for diagnosing evaluating and treating the patient’s condition and informing the patient. These can be visits appointments or non face-to-face interactions. Contacts can be visits to the general practitioner or other practices home visits admissions (in hospitals nursing homes or care homes psychiatric institutions or convalescent homes) or other relevant contacts. This includes past and future contacts.

The heart rate is the number of heartbeats per minute.

A SOAP report is a textual report of a (partial) consult with relation to a single problem according to the SOAP structure. SOAP (acronym for subjective objective assessment plan) is a method used by health professionals to structurally record information that comes up during contact between the patient and a health professionals in the patient's record. The following standardized format is used for reporting * Subjective the patient's complaint and request for help and the amnesic data * Objective the findings from the physical and supplementary examination. * Assessment the working hypothesis and the thinking process for example a differential diagnosis of the healthcare professional. * Plan the diagnostic plan or treatment plan and what has been discussed or agreed with the patient. The SOAP report is mainly used in general practice care. Note the zib doesn't state explicitly if zib SOAPReport pertains a consult or a partial consult but it has become clear that the zib and thus this profile should be interpreted as a partial consult with relation to a single problem (see ). The text above has been adjusted according to this insight.

Therapeutic or diagnostic procedure undergone by the patient (the complementary profile [nl-core-Procedure-request]() can be used for therapeutic or diagnostics procedures that the patient will undergo). A procedure can be a simple blood pressure measurement but also a complex heart surgery. In some care settings the term treatment is used instead of the term procedure.

The head circumference is the size of the head as measured around the head.

A person’s body height.

A contact is any interaction regardless of the situation between a patient and the healthcare provider in which the healthcare provider has primary responsibility for diagnosing evaluating and treating the patient’s condition and informing the patient. These can be visits appointments or non face-to-face interactions. Contacts can be visits to the general practitioner or other practices home visits admissions (in hospitals nursing homes or care homes psychiatric institutions or convalescent homes) or other relevant contacts. This includes past and future contacts.