StructureDefinition: Genetics - XML

Genetics

Raw XML

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="genetics"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div>
  </text>
  <url value="http://hl7.org/fhir/StructureDefinition/genetics"/>
  <name value="Standard Profile for Genetics"/>
  <status value="draft"/>
  <publisher value="Health Level Seven International (Clinical Genomics)"/>
  <contact>
    <telecom>
      <system value="other"/>
      <value value="http://www.hl7.org/Special/committees/clingenomics"/>
    </telecom>
  </contact>
  <date value="2015-03-18"/>
  <description value="Describes how the observation resource is used to report structured genetic test results"/>
  <kind value="resource"/>
  <constrainedType value="Observation"/>
  <abstract value="false"/>
  <base value="http://hl7.org/fhir/StructureDefinition/Observation"/>
  <snapshot>
    <element>
      <path value="Observation"/>
      <name value="Genetics"/>
      <short value="Measurements and simple assertions"/>
      <definition value="Measurements and simple assertions made about a patient, device or other subject."/>
      <comments value="Used for simple observations such as device measurements, laboratory atomic results, vital
       signs, height, weight, smoking status, comments, etc.  Other resources are used to provide
       context for observations such as Lab reports, etc."/>
      <alias value="Vital Signs"/>
      <alias value="Measurement"/>
      <alias value="Results"/>
      <alias value="Tests"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Observation"/>
      </type>
      <constraint>
        <key value="obs-6"/>
        <severity value="error"/>
        <human value="Shall only be present if Observation.value[x] is not present"/>
        <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))"/>
      </constraint>
      <constraint>
        <key value="obs-7"/>
        <severity value="error"/>
        <human value="Component code Shall not be same as observation code"/>
        <xpath value="not(exists(f:component.code/@value)) or (f:code/@value !=  f:component/f:code/@value)"/>
      </constraint>
      <mapping>
        <identity value="v2"/>
        <map value="OBX"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Observation[classCode=OBS, moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="clinical.diagnostics"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.id"/>
      <short value="Logical id of this artifact"/>
      <definition value="The logical id of the resource, as used in the url for the resource. Once assigned, this
       value never changes."/>
      <comments value="The only time that a resource does not have an id is when it is being submitted to the
       server using a create operation. Bundles always have an id, though it is usually a generated
       UUID."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="Observation.meta"/>
      <short value="Metadata about the resource"/>
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.
       Changes to the content may not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="Observation.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition value="A reference to a set of rules that were followed when the resource was constructed, and
       which must be understood when processing the content."/>
      <comments value="Asserting this rule set restricts the content to be only understood by a limited set of
       trading partners. This inherently limits the usefulness of the data in the long term.
       However the existing health eco-system is highly fractured, and not yet ready to define,
       collect, and exchange data in a generally computable sense. Wherever possible, implementers
       and/or specification writers should avoid using this element as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="Observation.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments value="Language is provided to support indexing and accessibility (typically, services such as
       text to speech use the language tag). The html language tag in the narrative applies 
       to the narrative. The language tag on the resource may be used to specify the language
       of other presentations generated from the data in the resource  Not all the content has
       to be in the base language. The Resource.language should not be assumed to apply to the
       narrative automatically. If a language is specified, it should it also be specified on
       the div element in the html (see rules in HTML5 for information about the relationship
       between xml:lang and the html lang attribute)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <strength value="required"/>
        <description value="A human language"/>
        <valueSetUri value="http://tools.ietf.org/html/bcp47"/>
      </binding>
    </element>
    <element>
      <path value="Observation.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition value="A human-readable narrative that contains a summary of the resource, and may be used to
       represent the content of the resource to a human. The narrative need not encode all the
       structured data, but is required to contain sufficient detail to make it &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/>
      <comments value="Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-1"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.contained"/>
      <short value="Contained, inline Resources"/>
      <definition value="These resources do not have an independent existence apart from the resource that contains
       them - they cannot be identified independently, and nor can they have their own independent
       transaction scope."/>
      <comments value="This should never be done when the content can be identified properly, as once identification
       is lost, it is extremely difficult (and context dependent) to restore it again."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.extension"/>
      <slicing>
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. In order to make the use of extensions safe and manageable, there is
       a strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomeBuild"/>
      <short value="GenomeBuild"/>
      <definition value="The Genome Build used for reference, following GRCh build versions e.g. 'GRCh 37'.  Version
       number must be included if a versioned release of a primary build was used."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomeBuild"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Chromosome"/>
      <short value="Chr"/>
      <definition value="The chromosome containing the genetic finding. The value set binds to Gene code system."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsChromosome"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicStart"/>
      <short value="Genomic Start"/>
      <definition value="Inclusive 0-based nucleotide position for start of genomic finding on the positive (+)
       genomics strand."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicStart"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicStop"/>
      <short value="GenomicEnd"/>
      <definition value="Exclusive 0-based nucleotide position for end of genomic finding on the positive (+) genomic
       strand."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicStop"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ReferenceAllele"/>
      <short value="RefAllele"/>
      <definition value="Nucleotide(s) from genomic start to genomic stop on the positive (+) strand of the genomic
       reference sequence."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsReferenceAllele"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ObservedAllele"/>
      <short value="ObsAllele"/>
      <definition value="Oserved nucleotides from genomic start to genomic stop on the positive (+) genomic strand."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsObservedAllele"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="TranscriptReferenceSequenceId"/>
      <short value="TransReferenceSeqID"/>
      <definition value="Reference identifier for cDNA transcript, with version, from NCBI's RefSeq or ENSEMBL."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsTranscriptReferenceSequenceId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ProteinReferenceSequenceId"/>
      <short value="ProteinReferenceSeq"/>
      <definition value="Reference identifier for protein transcript, with version, from NCBI's RefSeq or ENSEMBL."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsProteinReferenceSequenceId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="CIGAR"/>
      <short value="CIGAR"/>
      <definition value="Extended CIGAR string for aligning the sequence with reference bases. See detailed documentation
       [here](http://support.illumina.com/help/SequencingAnalysisWorkflow/Content/Vault/Informatics/Sequenc
      ing_Analysis/CASAVA/swSEQ_mCA_ExtendedCIGARFormat.htm)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsCIGAR"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNASequenceVariation"/>
      <short value="HGVSdnaVariant"/>
      <definition value="cDNA variant following HGVS nomenclature on the given TranscriptReferenceSequenceId."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNASequenceVariation"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="VariationId"/>
      <short value="VariantId"/>
      <definition value="Identifier for variant.  If a germline variant, ClinVar or dbSNP identifier should be
       used.  If a somatic variant, COSMIC identifier should be used, unless in ClinVar then
       either maybe used. Need to provide the code system used (ClinVar, dbSNP, COSMIC)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsVariationId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNASequenceVariationType"/>
      <short value="DNAvariantType"/>
      <definition value="Codified type for associated DNA Sequence Variation.  DNA Sequence Variations use the
       HGVS notation which implies the DNA Sequence Variation Type, but the concurrent use of
       this code will allow a standard and explicit type for technical and display convenience.
       LOINC Answer List values 48019-4 or Sequence Ontology vaues."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNASequenceVariationType"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AminoAcidChange"/>
      <short value="HGVSproteinChange"/>
      <definition value="Protein variant following HGVS nomenclature on the given ProteinReferenceSequenceId."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAminoAcidChange"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AminoAcidChangeType"/>
      <short value="ProteinChangeType"/>
      <definition value="Type of variation expressed using Sequence Ontology or LOINC answer list 48006-1."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAminoAcidChangeType"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Gene"/>
      <short value="Gene"/>
      <definition value="Gene region in which the sequence is found. Currently values from HGNC are supported.
       Other systems or genes not defined in HGNC (e.g. BCR-ABL fusion gene) can be added by
       using local extension."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGene"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNARegionName"/>
      <short value="RegionName"/>
      <definition value="Details of exonic location of variant (e.g. Exon 1)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNARegionName"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AlleleName"/>
      <short value="AlleleName"/>
      <definition value="Common name for variant or gene allele."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAlleleName"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicSourceClass"/>
      <short value="GenomicSource"/>
      <definition value="Genomic source class means category of source of tissue sample used to determine the sequence.
       Here is the loinc answer List for Allelic state:1. Germline LA6683-2; 2. Somatic LA6684-0;
       3. Prenatal LA6685-7; 4. Likely Germline LA18194-3; 5. Likely Somatic LA18195-0;  6. Likely
       Prenatal LA18196-8; 7. Unknown Genomic Origin LA18197-6."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicSourceClass"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Species"/>
      <short value="Species"/>
      <definition value="supports testing of human, viruses, and bacteria."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsSpecies"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Result"/>
      <short value="Result"/>
      <definition value="Results from genetic profile (e.g. One gene mutation with one type variation observed
       in a patient). It makes genetic profile support various genetic test(e.g. A genetic test
       reporting a list of gene mutations)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsResult"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AssessedCondition"/>
      <short value="AssessedCondition"/>
      <definition value="Used to denote condition context for genetic testing, which may influence reported variants
       and interpretation for large genomic testing panels e.g. lung cancer or familial breast
       cancer."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAssessedCondition"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AllelicState"/>
      <short value="AllelicState"/>
      <definition value="The level of occurrence of a single DNA Sequence Variation within a set of chromosomes.
       Heterozygous indicates the DNA Sequence Variation is only present in one of the two genes
       contained in homologous chromosomes. Homozygous indicates the DNA Sequence Variation is
       present in both genes contained in homologous chromosomes. Hemizygous indicates the DNA
       Sequence Variation exists in the only single copy of a gene in a non- homologous chromosome
       (the male X and Y chromosome are non-homologous). Hemiplasmic indicates that the DNA Sequence
       Variation is present in some but not all of the copies of mitochondrial DNA. Homoplasmic
       indicates that the DNA Sequence Variation is present in all of the copies of mitochondrial
       DNA. Here is the loinc answer List for Allelic state:1. Heteroplasmic (LA6703-8); 2. Homoplasmic
       (LA6704-6);  3. Homozygous (LA6705-3); 4. Heterozygous (LA6706-1); 5. Hemizygous (LA6707-9)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAllelicState"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AllelicFrequency"/>
      <short value="AllelicFrequency"/>
      <definition value="Allele frequencies."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAllelicFrequency"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="CopyNumberEvent"/>
      <short value="CopyNumberEvent"/>
      <definition value="Values: amplificaiton/deletion/LOH."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsCopyNumberEvent"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ReadCoverage"/>
      <short value="ReadCoverage"/>
      <definition value="Coverage (read depth or depth) is the average number of reads representing a given nucleotide
       in the reconstructed sequence."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsReadCoverage"/>
      </type>
    </element>
    <element>
      <path value="Observation.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource, and that modifies the understanding of the element that contains it.
       Usually modifier elements provide negation or qualification. In order to make the use
       of extensions safe and manageable, there is a strict set of governance applied to the
       definition and use of extensions. Though any implementer is allowed to define an extension,
       there is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.identifier"/>
      <short value="Unique Id for this particular observation"/>
      <definition value="A unique identifier for the simple observation instance."/>
      <requirements value="Allows observations to be distinguished and referenced."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.21"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="id"/>
      </mapping>
    </element>
    <element>
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final"/>
      </extension>
      <path value="Observation.status"/>
      <short value="registered | preliminary | final | amended +"/>
      <definition value="The status of the result value."/>
      <requirements value="Need to track the status of individual results - some results are finalised before the
       whole report is finalised."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isModifier value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Codes providing the status of an observation"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-status"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-11-observation result status"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct
         event with a type of &quot;revise&quot;"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="status"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.category"/>
      <short value="Classification of  type of observation"/>
      <definition value="A code that classifies the the general type of observation being made.  This is used 
       for searching, sorting and display purposes."/>
      <comments value="The level of granularity is defined by the category concepts in the value set.   More
       fine-grained filtering can be performed using the metadata and/or terminology hierarchy
       in Observation.code."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.category"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <strength value="example"/>
        <description value="Codes for high level observation categories"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-category"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quo
        t;].code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="class"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.code"/>
      <short value="Type of observation (code / type)"/>
      <definition value="Describes what was observed. Sometimes this is called the observation &quot;name&quot;."/>
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3-observation identifier"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="what"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.subject"/>
      <short value="Who and/or what this is about"/>
      <definition value="The patient, or group of patients, location, or device whose characteristics (direct or
       indirect) are described by the observation and into whose record the observation is placed.
        Comments: Indirect characteristics may be those of a specimen, fetus, donor,  other observer
       (for example a relative or EMT), or any observation made about the subject."/>
      <comments value="One would expect this element to be a cardinality  of 1..1.  The only circumstance in
       which the subject can be missing is when the observation is made by a device that does
       not know the patient. In this case, the observation SHALL be matched to a patient through
       some context/channel matching technique, and at this point, the observation should be
       updated.  If the target of the observation is different than the subject, the general
       extension [observation-focal-subject](extension-observation-focal-subject.html).  may
       be used.  However, the distinction between the patient's own value for an observation
       versus that of the fetus, or the donor or blood product unit, etc., are often specified
       in the observation code."/>
      <requirements value="Observations have no value if you don't know who or what they're about."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.subject"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Group"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Location"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3-patient ID list"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SBJ]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.focus"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.encounter"/>
      <short value="Healthcare event during which this observation is made"/>
      <definition value="The healthcare event  ( e.g. a patient and healthcare provider interaction ) during which
       this observation is made."/>
      <requirements value="For some observations it may be important to know the link between an observation and
       a particular encounter."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.encounter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="PV1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="context"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.effective[x]"/>
      <short value="Clinically Relevant time/time-period for observation"/>
      <definition value="The time or time-period the observed value is asserted as being true. For biological subjects
       - e.g. human patients - this is usually called the &quot;physiologically relevant time&quot;.
       This is usually either the time of the procedure or of specimen collection, but very often
       the source of the date/time is not known, only the date/time itself."/>
      <comments value="At least a date should be present unless this observation is a historical report."/>
      <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining
       trends."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.effective[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-14-date/time of the observation, and/or OBX-19 after v2.4  (depends on who observation
         made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="effectiveTime"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="when.done"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.issued"/>
      <short value="Date/Time this was made available"/>
      <definition value="The date and time this observation was made available to providers, typically after the
       results have been reviewed and verified."/>
      <comments value="Updated when the result is updated."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.issued"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="instant"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=AUT].time"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="when.recorded"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.performer"/>
      <short value="Who is responsible for the observation"/>
      <definition value="Who was responsible for asserting the observed value as &quot;true&quot;."/>
      <requirements value="May give a degree of confidence in the observation and also indicates where follow-up
       questions should be directed."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.performer"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Organization"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.15 / (Practitioner)  OBX-16-responsible observer,  PRT-5-participation person:PRT-4-participatio
        n='RO' /  (Device)  OBX-18-equipment instance identifier , PRT-10-participation device:PRT-4-particip
        ation='EQUIP' / (Organization)  OBX-23-performing organization name,  PRT-8-participation
         organization:PRT-4-participation='PO'"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=PRF]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.actor"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.value[x]"/>
      <short value="Actual result"/>
      <definition value="The information determined as a result of making the observation, if the information has
       a simple value."/>
      <comments value="Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. apgar store) may have both a value and related observations (for
       an apgar score, the observations from which the measure is derived). If a value is present,
       the datatype for this element should be determined by Observation.code. This element has
       a variable name depending on the type as follows: valueQuantity, valueCodeableConcept,
       valueString, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime,
       or valuePeriod. (The name format is &quot;'value' + the type name&quot; with a capital
       on the first letter of the type).   If the data element is usually coded or if the type
       associated with the Observation.value defines a coded value, use CodeableConcept instead
       of string datatype even if the value is uncoded text.  A value set is bound to the ValueCodeableConc
      ept element.  For boolean values use valueCodeableConcept and select codes from [HL7 Version
       2 Table 0136](v2/0136/index.html). These &quot;yes/no&quot; concepts can be mapped to
       the display name &quot;true/false&quot; or other mutually exclusive terms that may be
       needed.   For further discussion and examples see the  [notes section](observation.html#4.20.4)
       below."/>
      <requirements value="An observation exists to have a value, though it may not if it is in error, or it represents
       a group of observations."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="Attachment"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.dataAbsentReason"/>
      <short value="Why the result is missing"/>
      <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
      <comments value="Null or exceptional values can be represented two ways in FHIR Observations.  One way
       is to simply include them in the value set and represent the exceptions in the value.
        For example, measurement values for a serology test could be  &quot;detected&quot;, &quot;not
       detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   The
       alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed.  Because
       of these options, use-case agreements are required to interpret general observations for
       exceptional values."/>
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-6"/>
      <binding>
        <strength value="extensible"/>
        <description value="Codes specifying why the result (Observation.value[x]) is missing"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.interpretation"/>
      <short value="High, low, normal, etc."/>
      <definition value="The assessment made based on the result of the observation.  Intended as a simple compact
       code often placed adjacent to the result value in reports and flow sheets to signal the
       meaning/normalcy status of the result. Otherwise known as abnormal flag."/>
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result."/>
      <alias value="Abnormal Flag"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.interpretation"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8-interpretation codes"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.comments"/>
      <short value="Comments about result"/>
      <definition value="May include statements about significant, unexpected or unreliable values, or information
       about the source of the value where this may be relevant to the interpretation of the
       result."/>
      <requirements value="Need to be able to provide free text additional information."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.comments"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.bodySite"/>
      <short value="Observed body part"/>
      <definition value="Indicates the site on the subject's body where the observation was made ( i.e. the target
       site)."/>
      <comments value="Only used if not implicit in code found in Observation.code.  If the use case requires
       BodySite to be be handled as a separate resource instead of an inline coded element (
       e.g. to identify and track separately) then use the standard extension[ body-site-instance](extensio
      n-body-site-instance.html)."/>
      <requirements value="Knowing where the observation is made is important for tracking if multiple sites are
       possible."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.bodySite"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <strength value="example"/>
        <description value="Codes describing anatomical locations. May include laterality"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/body-site"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20-observation site"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.method"/>
      <short value="How it was done"/>
      <definition value="Indicates the mechanism used to perform the observation."/>
      <comments value="Only used if not implicit in code for Observation.code."/>
      <requirements value="In some cases, method can impact results and is thus for determining whether results can
       be compared or determining significance of results."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.method"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <strength value="example"/>
        <description value="Methods for simple observations"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-methods"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17-observation method"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="methodCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.specimen"/>
      <short value="Specimen used for this observation"/>
      <definition value="The specimen that was used when this observation was made."/>
      <comments value="Observations are not made on specimens themselves; they are made on a subject, but usually
       by the means of a specimen. Note that although specimens are often involved, they are
       not always tracked and reported explicitly. Also note that observation resources may be
       used in contexts that track the specimen explicitly (e.g. Diagnostic Report)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.specimen"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Specimen"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="SPM segment"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SPC].specimen"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.device"/>
      <short value="(Measurement) Device"/>
      <definition value="The device used to generate the observation data."/>
      <comments value="An extension should be used if further typing of the device is needed.  Devices used to
       support obtaining an observation can be represented using either extension or through
       the Observation.related element."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.device"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Device"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17 / PRT -10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=DEV]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange"/>
      <name value="referenceRange"/>
      <short value="Provides guide for interpretation"/>
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
      <comments value="Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.
       specific to the patient's age, gender, weight and other factors), but this may not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="obs-3"/>
        <severity value="error"/>
        <human value="Must have at least a low or a high or text"/>
        <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/>
      </constraint>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.id"/>
      <representation value="xmlAttr"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.low"/>
      <short value="Low Range, if relevant"/>
      <definition value="The value of the low bound of the reference range.  The low bound of the reference range
       endpoint is inclusive of the value (e.g.  reference range is &gt;=5 - &lt;=9).   If the
       low bound is omitted,  it is assumed to be meaningless. (e.g. reference range is &lt;=2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.low"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7-references range"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.low"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.high"/>
      <short value="High Range, if relevant"/>
      <definition value="The value of the high bound of the reference range.  The high bound of the reference range
       endpoint is inclusive of the value (e.g.  reference range is &gt;=5 - &lt;=9).   If the
       high bound is omitted,  it is assumed to be meaningless. (e.g. reference range is &gt;=
       2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.high"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7-references range"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.high"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.meaning"/>
      <short value="Indicates the meaning/use of this range of this range"/>
      <definition value="Code for the meaning of the reference range."/>
      <comments value="This SHOULD be populated if there is more than one range."/>
      <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic,
       or perhaps what state this reference range applies to (i.e. age, hormonal cycles, etc.)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.meaning"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <binding>
        <strength value="example"/>
        <description value="Code for the meaning of a reference range"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10-nature of abnormal test?"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.age"/>
      <short value="Applicable age range, if relevant"/>
      <definition value="The age at which this reference range is applicable. This is a neonatal age (e.g. number
       of weeks at term) if the meaning says so."/>
      <requirements value="Some analytes vary greatly over age."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.age"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Range"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.referenceRange.text"/>
      <short value="Text based reference range in an observation"/>
      <definition value="Text based reference range in an observation which may be used when a quantitative range
       is not appropriate for an observation.  An example would be a reference value of &quot;Negative&quot
      ; or a list or table of 'normals'."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7-references range"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:ST"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related"/>
      <short value="Resource related to this observation"/>
      <definition value="A  reference to another resource ( usally another Observation but could  also be a QuestionnaireAnsw
      er) whose relationship is defined by the relationship type code."/>
      <comments value="For a discussion on the ways Observations can assembled in groups together see [Notes
       below](observation.html#4.20.4)."/>
      <requirements value="Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. apgar store) may have both a value and a set of related observations
       or sometimes QuestionnaireResponse  from which the measure is derived."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.id"/>
      <representation value="xmlAttr"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.related.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.related.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.type"/>
      <short value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
      <definition value="A code specifying the kind of relationship that exists with the target resource."/>
      <comments value="&quot;derived-from&quot; is only logical choice when referencing QuestionnaireAnswer resource."/>
      <requirements value="A relationship type SHOULD be provided."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related.type"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <strength value="required"/>
        <description value="Codes specifying how two observations are related"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.related.target"/>
      <short value="Resource that is related to this one"/>
      <definition value="A reference to the observation or questionnaireanswer that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.related.target"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component"/>
      <short value="Component results"/>
      <definition value="Some observations have multiple component observations.  These component observations
       are expressed as separate code value pairs that share the same attributes.  Examples include
       systolic and diastolic component observations for blood pressure measurement and multiple
       component observations for for genetics observations."/>
      <comments value="For a discussion on the ways Observations can assembled in groups together see [Notes
       below](observation.html#4.20.4)."/>
      <requirements value="Component observations share the same attributes in the Observation resource as the primary
       observation and are always treated a part of a single observation ( they are not seperable).
         However, the reference range for the primary observation value is not inherited by the
       component values and is required when appropriate for each component observation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship[typeCode=COMP]"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.id"/>
      <representation value="xmlAttr"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.code"/>
      <short value="Type of component observation (code / type)"/>
      <definition value="Describes what was observed. Sometimes this is called the observation &quot;code&quot;."/>
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-7"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3-observation identifier"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="what"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.value[x]"/>
      <short value="Actual component result"/>
      <definition value="The information determined as a result of making the observation, if the information has
       a simple value."/>
      <comments value="Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. apgar store) may have both a value and related observations (for
       an apgar score, the observations from which the measure is derived). If a value is present,
       the datatype for this element should be determined by Observation.code. A CodeableConcept
       with just a text would be used instead of a string if the field was usually coded, or
       if the type associated with the Observation.code defines a coded value.   For boolean
       values use valueCodeableConcept and select codes from &lt;http://hl7.org/fhir/ValueSet/v2-0136&gt;
       (These &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot;
       or other mutually exclusive terms that may be needed&quot;).  The element, Observation.value[x],
       has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept,
       valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (The name format
       is &quot;'value' + the type name&quot; with a capital on the first letter of the type)."/>
      <requirements value="An observation exists to have a value, though it may not if it is in error, or it represents
       a group of observations."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="Attachment"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.dataAbsentReason"/>
      <short value="Why the component result is missing"/>
      <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
      <comments value="&quot;Null&quot; or exceptional values can be represented two ways in FHIR Observations.
        One way is to simply include them in the value set and represent the exceptions in the
       value.  For example, measurement values for a serology test could be  &quot;detected&quot;,
       &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;.   The
       alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed.  Because
       of these options, use-case agreements are required to interpret general observations for
       exceptional values."/>
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-6"/>
      <binding>
        <strength value="extensible"/>
        <description value="Codes specifying why the result (Observation.value[x]) is missing"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element>
      <path value="Observation.component.referenceRange"/>
      <short value="Provides guide for interpretation ofcomponent result"/>
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
      <comments value="Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.
       specific to the patient's age, gender, weight and other factors), but this may not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <nameReference value="referenceRange"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element>
      <path value="Observation"/>
      <name value="Genetics"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Observation"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomeBuild"/>
      <slicing>
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="GenomeBuild"/>
      <definition value="The Genome Build used for reference, following GRCh build versions e.g. 'GRCh 37'.  Version
       number must be included if a versioned release of a primary build was used."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomeBuild"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Chromosome"/>
      <short value="Chr"/>
      <definition value="The chromosome containing the genetic finding. The value set binds to Gene code system."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsChromosome"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicStart"/>
      <short value="Genomic Start"/>
      <definition value="Inclusive 0-based nucleotide position for start of genomic finding on the positive (+)
       genomics strand."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicStart"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicStop"/>
      <short value="GenomicEnd"/>
      <definition value="Exclusive 0-based nucleotide position for end of genomic finding on the positive (+) genomic
       strand."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicStop"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ReferenceAllele"/>
      <short value="RefAllele"/>
      <definition value="Nucleotide(s) from genomic start to genomic stop on the positive (+) strand of the genomic
       reference sequence."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsReferenceAllele"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ObservedAllele"/>
      <short value="ObsAllele"/>
      <definition value="Oserved nucleotides from genomic start to genomic stop on the positive (+) genomic strand."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsObservedAllele"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="TranscriptReferenceSequenceId"/>
      <short value="TransReferenceSeqID"/>
      <definition value="Reference identifier for cDNA transcript, with version, from NCBI's RefSeq or ENSEMBL."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsTranscriptReferenceSequenceId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ProteinReferenceSequenceId"/>
      <short value="ProteinReferenceSeq"/>
      <definition value="Reference identifier for protein transcript, with version, from NCBI's RefSeq or ENSEMBL."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsProteinReferenceSequenceId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="CIGAR"/>
      <short value="CIGAR"/>
      <definition value="Extended CIGAR string for aligning the sequence with reference bases. See detailed documentation
       [here](http://support.illumina.com/help/SequencingAnalysisWorkflow/Content/Vault/Informatics/Sequenc
      ing_Analysis/CASAVA/swSEQ_mCA_ExtendedCIGARFormat.htm)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsCIGAR"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNASequenceVariation"/>
      <short value="HGVSdnaVariant"/>
      <definition value="cDNA variant following HGVS nomenclature on the given TranscriptReferenceSequenceId."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNASequenceVariation"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="VariationId"/>
      <short value="VariantId"/>
      <definition value="Identifier for variant.  If a germline variant, ClinVar or dbSNP identifier should be
       used.  If a somatic variant, COSMIC identifier should be used, unless in ClinVar then
       either maybe used. Need to provide the code system used (ClinVar, dbSNP, COSMIC)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsVariationId"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNASequenceVariationType"/>
      <short value="DNAvariantType"/>
      <definition value="Codified type for associated DNA Sequence Variation.  DNA Sequence Variations use the
       HGVS notation which implies the DNA Sequence Variation Type, but the concurrent use of
       this code will allow a standard and explicit type for technical and display convenience.
       LOINC Answer List values 48019-4 or Sequence Ontology vaues."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNASequenceVariationType"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AminoAcidChange"/>
      <short value="HGVSproteinChange"/>
      <definition value="Protein variant following HGVS nomenclature on the given ProteinReferenceSequenceId."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAminoAcidChange"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AminoAcidChangeType"/>
      <short value="ProteinChangeType"/>
      <definition value="Type of variation expressed using Sequence Ontology or LOINC answer list 48006-1."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAminoAcidChangeType"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Gene"/>
      <short value="Gene"/>
      <definition value="Gene region in which the sequence is found. Currently values from HGNC are supported.
       Other systems or genes not defined in HGNC (e.g. BCR-ABL fusion gene) can be added by
       using local extension."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGene"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="DNARegionName"/>
      <short value="RegionName"/>
      <definition value="Details of exonic location of variant (e.g. Exon 1)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsDNARegionName"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AlleleName"/>
      <short value="AlleleName"/>
      <definition value="Common name for variant or gene allele."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAlleleName"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="GenomicSourceClass"/>
      <short value="GenomicSource"/>
      <definition value="Genomic source class means category of source of tissue sample used to determine the sequence.
       Here is the loinc answer List for Allelic state:1. Germline LA6683-2; 2. Somatic LA6684-0;
       3. Prenatal LA6685-7; 4. Likely Germline LA18194-3; 5. Likely Somatic LA18195-0;  6. Likely
       Prenatal LA18196-8; 7. Unknown Genomic Origin LA18197-6."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsGenomicSourceClass"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Species"/>
      <short value="Species"/>
      <definition value="supports testing of human, viruses, and bacteria."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsSpecies"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="Result"/>
      <short value="Result"/>
      <definition value="Results from genetic profile (e.g. One gene mutation with one type variation observed
       in a patient). It makes genetic profile support various genetic test(e.g. A genetic test
       reporting a list of gene mutations)."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsResult"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AssessedCondition"/>
      <short value="AssessedCondition"/>
      <definition value="Used to denote condition context for genetic testing, which may influence reported variants
       and interpretation for large genomic testing panels e.g. lung cancer or familial breast
       cancer."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAssessedCondition"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AllelicState"/>
      <short value="AllelicState"/>
      <definition value="The level of occurrence of a single DNA Sequence Variation within a set of chromosomes.
       Heterozygous indicates the DNA Sequence Variation is only present in one of the two genes
       contained in homologous chromosomes. Homozygous indicates the DNA Sequence Variation is
       present in both genes contained in homologous chromosomes. Hemizygous indicates the DNA
       Sequence Variation exists in the only single copy of a gene in a non- homologous chromosome
       (the male X and Y chromosome are non-homologous). Hemiplasmic indicates that the DNA Sequence
       Variation is present in some but not all of the copies of mitochondrial DNA. Homoplasmic
       indicates that the DNA Sequence Variation is present in all of the copies of mitochondrial
       DNA. Here is the loinc answer List for Allelic state:1. Heteroplasmic (LA6703-8); 2. Homoplasmic
       (LA6704-6);  3. Homozygous (LA6705-3); 4. Heterozygous (LA6706-1); 5. Hemizygous (LA6707-9)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAllelicState"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="AllelicFrequency"/>
      <short value="AllelicFrequency"/>
      <definition value="Allele frequencies."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsAllelicFrequency"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="CopyNumberEvent"/>
      <short value="CopyNumberEvent"/>
      <definition value="Values: amplificaiton/deletion/LOH."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsCopyNumberEvent"/>
      </type>
    </element>
    <element>
      <path value="Observation.extension"/>
      <name value="ReadCoverage"/>
      <short value="ReadCoverage"/>
      <definition value="Coverage (read depth or depth) is the average number of reads representing a given nucleotide
       in the reconstructed sequence."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Extension"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/geneticsReadCoverage"/>
      </type>
    </element>
    <element>
      <path value="Observation.component"/>
      <min value="0"/>
      <max value="*"/>
    </element>
  </differential>
</StructureDefinition>