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One or more  refinements  may be added to a  concept  to qualify it. This is done by putting the  concept  to be qualified before a colon and the qualifying  expression  after. The qualifying  expression  is of the form "attribute = value". The example below describes an operation to remove an ovary (i.e. an 'oophorectomy') using a laser.
83152002|oophorectomy|:
405815000|procedure device| = 122456005|laser device|
The next example, shown below, describes the right hip joint.
182201002|hip joint|:
272741003|laterality| = 24028007|right|
Where more than one qualifying attribute is required, these can be separated using a comma. The example below describes the removal of an ovarian structure using a laser device.
71388002|procedure|:
405815000|procedure device| = 122456005|laser device|,
260686004|method| = 129304002 |excision - action|,
405813007|procedure site - direct| = 15497006 |ovarian structure|
A further example, below, describes the emergency removal of the appendix:
65801008|excision|:
405813007|procedure site - direct| = 66754008|appendix structure|,
260870009|priority| = 25876001|emergency|
Refinements may also be applied to a conjoined  concept . For example, the following two expressions are equivalent (because an 'ulna' is a bone in an 'upper limb'):
313056006|epiphysis of ulna|: 272741003|laterality| = 7771000|left|
119189000|ulna part| + 312845000|epiphysis of upper limb|:
272741003|laterality| = 7771000|left|
Note that there are no brackets round "119189000 |ulna part| + 312845000 |epiphysis of upper limb|" in the above example, as the refinement automatically applies to the conjoined concept.

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