One or more may be added to a to qualify it. This is done by putting the to be qualified before a colon and the qualifying after. The qualifying 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 . 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.