GAO Ballot Package
This page is part of the FHIR Specification (v1.1.0: STU 3 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
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This is a frozen snapshot of the FHIR specification created for the purpose of balloting the GAO implementation Guide. It includes draft changes that may be part of the future DSTU 2.1 release but further change is expected. Readers should focus solely on the GAO implementation content, and FHIR DSTU 2 for other purposes.
Clinical assessment tool example - GCS using related Observations
{
"resourceType": "Observation",
"id": "glasgow",
"text": {
"status": "generated",
"div": "<div><p><b>Generated Narrative with Details</b></p><p><b>id</b>: glasgow</p><p><b>contained</b>: , , </p><p><b>status</b>: final</p><p><b>code</b>: Glasgow Coma Scale , (GCS) <span>(Details : {LOINC code '9269-2' = 'Glasgow coma score total', given as 'Glasgow coma score total'})</span></p><p><b>subject</b>: <a>Peter James Chalmers</a></p><p><b>effective</b>: 11/12/2014 3:44:16 PM</p><p><b>value</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = '??')</span></p><blockquote><p><b>referenceRange</b></p><p><b>high</b>: 8 {score}<span> (Details: http://unitsofmeasure.org code {score} = '??')</span></p><p><b>meaning</b>: Severe TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 9 {score}<span> (Details: http://unitsofmeasure.org code {score} = '??')</span></p><p><b>high</b>: 12 {score}<span> (Details: http://unitsofmeasure.org code {score} = '??')</span></p><p><b>meaning</b>: Moderate TBI <span>(Details )</span></p></blockquote><blockquote><p><b>referenceRange</b></p><p><b>low</b>: 13 {score}<span> (Details: http://unitsofmeasure.org code {score} = '??')</span></p><p><b>meaning</b>: Mild TBI <span>(Details )</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Motor score. Generated Summary: id: motor; status: final; GCS motor <span>(Details : {LOINC code '9268-4' = 'Glasgow coma score motor', given as 'Glasgow coma score motor'})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 5 (Localizes painful stimuli) <span>(Details : {http:/acme.ec/gcsmotor code '5' = '??', given as 'Localizes painful stimuli'}; {LOINC code 'LA6566-9' = 'Localizing pain', given as 'Localizing pain'})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Verbal score. Generated Summary: id: verbal; status: final; Verbal <span>(Details : {LOINC code '9270-0' = 'Glasgow coma score verbal', given as 'Glasgow coma score verbal'})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 4 (Confused, disoriented) <span>(Details : {http:/acme.ec/gcsverbal code '4' = '??', given as 'Confused, disoriented'}; {LOINC code 'LA6560-2' = 'Confused', given as 'Confused'})</span></p></blockquote><blockquote><p><b>related</b></p><p><b>type</b>: derived-from</p><p><b>target</b>: Eyes score. Generated Summary: id: eyes; status: final; Eyes <span>(Details : {LOINC code '9267-6' = 'Glasgow coma score eye opening', given as 'Glasgow coma score eye opening'})</span>; Patient/example; effective: 11/12/2014 3:44:16 PM; 4 (Opens eyes spontaneously) <span>(Details : {http:/acme.ec/gcseye code '4' = '??', given as 'Opens eyes spontaneously'}; {LOINC code 'LA6556-0' = 'Eyes open spontaneously', given as 'Eyes open spontaneously'})</span></p></blockquote></div>"
},
"contained": [
{
"resourceType": "Observation",
"id": "motor",
"status": "final",
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "9268-4",
"display": "Glasgow coma score motor"
}
],
"text": "GCS motor"
},
"subject": {
"reference": "Patient/example"
},
"effectiveDateTime": "2014-12-11T04:44:16Z",
"valueCodeableConcept": {
"coding": [
{
"system": "http:/acme.ec/gcsmotor",
"code": "5",
"display": "Localizes painful stimuli"
},
{
"extension": [
{
"fhir_comments": [
" This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource ",
" 0..1 Value of extension "
],
"url": "http://hl7.org/fhir/StructureDefinition/iso21090-CO-value",
"valueDecimal": 5,
"_valueDecimal": {
"fhir_comments": [
" from Element: extension "
]
}
}
],
"system": "http://loinc.org",
"code": "LA6566-9",
"display": "Localizing pain"
}
],
"text": "5 (Localizes painful stimuli)"
}
},
{
"resourceType": "Observation",
"id": "verbal",
"status": "final",
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "9270-0",
"display": "Glasgow coma score verbal"
}
],
"text": "Verbal"
},
"subject": {
"reference": "Patient/example"
},
"effectiveDateTime": "2014-12-11T04:44:16Z",
"valueCodeableConcept": {
"coding": [
{
"system": "http:/acme.ec/gcsverbal",
"code": "4",
"display": "Confused, disoriented"
},
{
"extension": [
{
"fhir_comments": [
" This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource ",
" 0..1 Value of extension "
],
"url": "http://hl7.org/fhir/StructureDefinition/iso21090-CO-value",
"valueDecimal": 4,
"_valueDecimal": {
"fhir_comments": [
" from Element: extension "
]
}
}
],
"system": "http://loinc.org",
"code": "LA6560-2",
"_code": {
"fhir_comments": [
" technicallly the code is '5' and the LA is the identifier to do hav e both would require an extention "
]
},
"display": "Confused"
}
],
"text": "4 (Confused, disoriented)"
}
},
{
"resourceType": "Observation",
"id": "eyes",
"status": "final",
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "9267-6",
"display": "Glasgow coma score eye opening"
}
],
"text": "Eyes"
},
"subject": {
"reference": "Patient/example"
},
"effectiveDateTime": "2014-12-11T04:44:16Z",
"valueCodeableConcept": {
"coding": [
{
"system": "http:/acme.ec/gcseye",
"code": "4",
"display": "Opens eyes spontaneously"
},
{
"extension": [
{
"fhir_comments": [
" This example has the extension which maps a numeric score to the code this may already be known and unecessary in the Observation resource ",
" 0..1 Value of extension "
],
"url": "http://hl7.org/fhir/StructureDefinition/iso21090-CO-value",
"valueDecimal": 4,
"_valueDecimal": {
"fhir_comments": [
" from Element: extension "
]
}
}
],
"system": "http://loinc.org",
"code": "LA6556-0",
"_code": {
"fhir_comments": [
" technicallly the code is '4' and the LA is the identifier to do hav e both would require an extention "
]
},
"display": "Eyes open spontaneously"
}
],
"text": "4 (Opens eyes spontaneously)"
}
}
],
"status": "final",
"_status": {
"fhir_comments": [
" the mandatory quality flags: "
]
},
"code": {
"fhir_comments": [
" \n Observations are often coded in multiple code systems.\n - LOINC\n\t\t- or SNOMED\n -and/or the source system may provides its own \"local\" code, which may be less or more granular than LOINC.\n\tIn this example there is only LOINC\n "
],
"coding": [
{
"fhir_comments": [
" LOINC - always recommended to have a LOINC code "
],
"system": "http://loinc.org",
"code": "9269-2",
"display": "Glasgow coma score total"
}
],
"text": "Glasgow Coma Scale , (GCS)"
},
"subject": {
"reference": "Patient/example",
"display": "Peter James Chalmers"
},
"effectiveDateTime": "2014-12-11T04:44:16Z",
"valueQuantity": {
"fhir_comments": [
" In FHIR, units may be represented twice. Once in the\n agreed human representation, and once in a coded form.\n In this example the UCUM unit is provided but no human representation since this is often not displayed\n "
],
"value": 13,
"system": "http://unitsofmeasure.org",
"code": "{score}"
},
"referenceRange": [
{
"high": {
"value": 8,
"system": "http://unitsofmeasure.org",
"code": "{score}"
},
"meaning": {
"fhir_comments": [
" meaning as text "
],
"text": "Severe TBI"
}
},
{
"low": {
"value": 9,
"system": "http://unitsofmeasure.org",
"code": "{score}"
},
"high": {
"value": 12,
"system": "http://unitsofmeasure.org",
"code": "{score}"
},
"meaning": {
"fhir_comments": [
" meaning as text "
],
"text": "Moderate TBI"
}
},
{
"low": {
"value": 13,
"system": "http://unitsofmeasure.org",
"code": "{score}"
},
"meaning": {
"fhir_comments": [
" meaning as text "
],
"text": "Mild TBI"
}
}
],
"related": [
{
"fhir_comments": [
" put the references to the contained components here using the derived-From type "
],
"type": "derived-from",
"target": {
"reference": "#motor",
"display": "Motor score"
}
},
{
"type": "derived-from",
"target": {
"reference": "#verbal",
"display": "Verbal score"
}
},
{
"type": "derived-from",
"target": {
"reference": "#eyes",
"display": "Eyes score"
}
}
]
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR DSTU2 (v1.1.0-7375) generated on Thu, Dec 3, 2015 10:00+1100.
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