R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

10.1.18.67 StructureDefinition: BMI

(No assigned work group) Maturity Level: 1Informative Use Context: Any

The official URL for this profile is: 

http://hl7.org/fhir/StructureDefinition/bmi

FHIR Body Mass Index (BMI) Profile

This profile was published on Fri, Mar 25, 2016 00:00+1100 as a draft by Health Level Seven International (Orders and Observations Workgroup).

10.1.18.67.1 Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Vital Signs Profile.

Summary

10.1.18.67.2 Complete Summary of the Mandatory Requirements

  1. One code in Observation.code which must have
    • a fixed Observation.code.coding.system='http ://loinc.org'
    • a fixed Observation.code.coding.code= '39156-5'
    • Other additional Codings are allowed in Observation.code- e.g. more specific LOINC Codes, SNOMED CT concepts, system specific codes. All codes SHALL have an system value
  2. a fixedObservation.valueQuantity.code = 'kg/m2'

Fixed Value: 3 elements

Slices

This structure defines the following Slices:

  • The element Observation.code.coding is sliced based on the value of value:code

This structure is derived from Vital Signs Profile.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*FHIR Body Mass Index (BMI) Profile
... code 1..1CodeableConceptBody Mass Index (BMI)
.... coding CodingSlice: Unordered, Open by value:code
.... coding 0..*Coding
..... system 0..1uriFixed Value: http://loinc.org
..... code 0..1codeFixed Value: 39156-5
... valueQuantity 0..1Quantity
.... code 1..1codeFixed Value: kg/m2

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*FHIR Body Mass Index (BMI) Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration), Reference(MedicationDispense), Reference(MedicationStatement), Reference(Procedure), Reference(Immunization), Reference(ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category SI1..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
... code SΣ1..1CodeableConceptBody Mass Index (BMI)
Binding: Vital Signs (extensible)
.... id 0..1stringxml:id (or equivalent in JSON)
.... coding ΣCodingCode defined by a terminology system
Slice: Unordered, Open by value:code
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... system Σ0..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ0..1codeSymbol in syntax defined by the system
Fixed Value: 39156-5
..... display Σ0..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(Patient)Who and/or what this is about
... context 0..1Reference(Encounter), Reference(EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] SΣI1..1dateTime, PeriodOften just a dateTime for Vital Signs
vs-1: Datetime must be at least to day.
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner), Reference(PractitionerRole), Reference(Organization), Reference(CareTeam), Reference(Patient), Reference(RelatedPerson)Who is responsible for the observation
... valueQuantity SΣI0..1QuantityVital Sign Value recorded with UCUM
Binding: Vital Signs Units (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... value SΣ1..1decimalNumerical value (with implicit precision)
.... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
.... unit SΣ1..1stringUnit representation
.... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
.... code SΣ1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: kg/m2
... dataAbsentReason SI0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device), Reference(DeviceComponent), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember SΣ0..*Reference(VitalSigns)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference), Reference(ImagingStudy), Reference(Media), Reference(QuestionnaireResponse), Reference(Observation), Reference(Sequence)Related measurements the observation is made from
... component SΣI0..*BackboneElementUsed when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: Vital Signs (extensible)
.... valueQuantity SΣ0..1QuantityVital Sign Value recorded with UCUM
Binding: Vital Signs Units (required)
..... id 0..1stringxml:id (or equivalent in JSON)
..... value SΣ1..1decimalNumerical value (with implicit precision)
..... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit SΣ1..1stringUnit representation
..... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ1..1codeCoded responses from the common UCUM units for vital signs value set.
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format
<!-- Vital Signs Profile -->doco

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- 0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!-- 0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!-- 0..1 Language of the resource content  -->
 <text><!-- 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- 0..* Identifier 
     Business Identifier for observation --></identifier>
 <basedOn><!-- 0..* Reference(CarePlan)|Reference(DeviceRequest)|Reference(ImmunizationRecommendation)|Reference(MedicationRequest)|
   Reference(NutritionOrder)|Reference(ServiceRequest) Fulfills plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration)|Reference(MedicationDispense)|Reference(MedicationStatement)|Reference(Procedure)|Reference(Immunization)|
   Reference(ImagingStudy) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended +  -->
 <category><!-- ?? 1..* CodeableConcept Classification of  type of observation  --></category>
 <code> 1..1 CodeableConcept  <!-- 1..1 Body Mass Index (BMI) -->
  <-- coding sliced by value:code  in the specified orderOpen-->
  <coding> 0..* Coding  <!-- 0..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- 0..1 Identity of the terminology system -->
   <version value="[string]"/><!-- 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- 0..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!-- 0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!-- 0..1 If this coding was chosen directly by the user -->
  </coding>
  <text value="[string]"/><!-- 0..1 Plain text representation of the concept -->
 </code>
 <subject><!-- 1..1 Reference(Patient) Who and/or what this is about --></subject>
 <context><!-- 0..1 Reference(Encounter)|Reference(EpisodeOfCare) 
     Healthcare event during which this observation is made --></context>
 <effective[x]><!-- ?? 1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!-- 0..1 Date/Time this version was made available -->
 <performer><!-- 0..* Reference(Practitioner)|Reference(PractitionerRole)|Reference(Organization)|Reference(CareTeam)|
   Reference(Patient)|Reference(RelatedPerson) Who is responsible for the observation --></performer>
 <valueQuantity> 0..1 Quantity  <!-- 0..1 Vital Sign Value recorded with UCUM -->
  <value value="[decimal]"/><!-- 1..1 Numerical value (with implicit precision) -->
  <comparator value="[code]"/><!-- 0..1 < | <= | >= | > - how to understand the value  -->
  <unit value="[string]"/><!-- 1..1 Unit representation -->
  <system value="[uri]"/><!-- 1..1 System that defines coded unit form -->
  <code value="[code]"/><!-- 1..1 
      Coded responses from the common UCUM units for vital signs value set. -->
 </valueQuantity>
 <dataAbsentReason><!-- 0..1 CodeableConcept Why the result is missing  --></dataAbsentReason>
 <interpretation><!-- 0..1 CodeableConcept High, low, normal, etc.  --></interpretation>
 <comment value="[string]"/><!-- 0..1 Comments about result -->
 <bodySite><!-- 0..1 CodeableConcept Observed body part  --></bodySite>
 <method><!-- 0..1 CodeableConcept How it was done  --></method>
 <specimen><!-- 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- 0..1 Reference(Device)|Reference(DeviceComponent)|Reference(DeviceMetric) 
     (Measurement) Device --></device>
 <referenceRange> ?? 0..* BackboneElement  <!-- ?? 0..* Provides guide for interpretation -->
  <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
  <low><!-- 0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!-- 0..1 Quantity 
      High Range, if relevant --></high>
  <type><!-- 0..1 CodeableConcept Reference range qualifier  --></type>
  <appliesTo><!-- 0..* CodeableConcept Reference range population  --></appliesTo>
  <age><!-- 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[string]"/><!-- 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- 0..* Reference(Vital Signs Profile) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- 0..* Reference(DocumentReference)|Reference(ImagingStudy)|Reference(Media)|Reference(QuestionnaireResponse)|
   Reference(Observation)|Reference(Sequence) Related measurements the observation is made from --></derivedFrom>
 <component> ?? 0..* BackboneElement  <!-- ?? 0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
  <code><!-- 1..1 CodeableConcept Type of component observation (code / type)  --></code>
  <valueQuantity> 0..1 Quantity  <!-- 0..1 Vital Sign Value recorded with UCUM -->
   <value value="[decimal]"/><!-- 1..1 Numerical value (with implicit precision) -->
   <comparator value="[code]"/><!-- 0..1 < | <= | >= | > - how to understand the value  -->
   <unit value="[string]"/><!-- 1..1 Unit representation -->
   <system value="[uri]"/><!-- 1..1 System that defines coded unit form -->
   <code value="[code]"/><!-- 1..1 
       Coded responses from the common UCUM units for vital signs value set. -->
  </valueQuantity>
  <dataAbsentReason><!-- 0..1 CodeableConcept Why the component result is missing  --></dataAbsentReason>
  <interpretation><!-- 0..1 CodeableConcept High, low, normal, etc.  --></interpretation>
  <referenceRange><!-- See #Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

{ // Vital Signs Profile
  // from Element: extension
    "meta" : { Meta }, //Metadata about the resource
    "implicitRules" : "<uri>", //A set of rules under which this content was created
    "language" : "<code>", //Language of the resource content 
    "text" : { Narrative }, //Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], //Extensions that cannot be ignored
    "identifier" : [{ Identifier }], //Business Identifier for observation
// value[x]: Fulfills plan, proposal or order. One of these 6:
    "basedOn" : [{ Reference(CarePlan) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(DeviceRequest) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(ImmunizationRecommendation) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(MedicationRequest) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(NutritionOrder) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(ServiceRequest) }], //Fulfills plan, proposal or order
// value[x]: Part of referenced event. One of these 6:
    "partOf" : [{ Reference(MedicationAdministration) }], //Part of referenced event
    "partOf" : [{ Reference(MedicationDispense) }], //Part of referenced event
    "partOf" : [{ Reference(MedicationStatement) }], //Part of referenced event
    "partOf" : [{ Reference(Procedure) }], //Part of referenced event
    "partOf" : [{ Reference(Immunization) }], //Part of referenced event
    "partOf" : [{ Reference(ImagingStudy) }], //Part of referenced event
    "status" : "<code>", // R! registered | preliminary | final | amended + 
    "category" : [{ CodeableConcept }], // C? R! Classification of  type of observation 
    "code" : { CodeableConcept }, // R! Body Mass Index (BMI) 
    "subject" : { Reference(Patient) }, // R! Who and/or what this is about
// value[x]: Healthcare event during which this observation is made. One of these 2:
    "context" : { Reference(Encounter) }, //Healthcare event during which this observation is made
    "context" : { Reference(EpisodeOfCare) }, //Healthcare event during which this observation is made
// value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // C? R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // C? R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", //Date/Time this version was made available
// value[x]: Who is responsible for the observation. One of these 6:
    "performer" : [{ Reference(Practitioner) }] //Who is responsible for the observation
    "performer" : [{ Reference(PractitionerRole) }], //Who is responsible for the observation
    "performer" : [{ Reference(Organization) }], //Who is responsible for the observation
    "performer" : [{ Reference(CareTeam) }], //Who is responsible for the observation
    "performer" : [{ Reference(Patient) }], //Who is responsible for the observation
    "performer" : [{ Reference(RelatedPerson) }], //Who is responsible for the observation
    "valueQuantity" : { Quantity }, //Vital Sign Value recorded with UCUM 
    "dataAbsentReason" : { CodeableConcept }, //Why the result is missing 
    "interpretation" : { CodeableConcept }, //High, low, normal, etc. 
    "comment" : "<string>", //Comments about result
    "bodySite" : { CodeableConcept }, //Observed body part 
    "method" : { CodeableConcept }, //How it was done 
    "specimen" : { Reference(Specimen) }, //Specimen used for this observation
// value[x]: (Measurement) Device. One of these 3:
    "device" : { Reference(Device) }, //(Measurement) Device
    "device" : { Reference(DeviceComponent) }, //(Measurement) Device
    "device" : { Reference(DeviceMetric) }, //(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(vitalsigns) }], //Used when reporting vital signs panel components
// value[x]: Related measurements the observation is made from. One of these 6:
    "derivedFrom" : [{ Reference(DocumentReference) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(ImagingStudy) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Media) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(QuestionnaireResponse) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Observation) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Sequence) }], //Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }

This structure is derived from Vital Signs Profile.

Summary

10.1.18.67.3 Complete Summary of the Mandatory Requirements

  1. One code in Observation.code which must have
    • a fixed Observation.code.coding.system='http ://loinc.org'
    • a fixed Observation.code.coding.code= '39156-5'
    • Other additional Codings are allowed in Observation.code- e.g. more specific LOINC Codes, SNOMED CT concepts, system specific codes. All codes SHALL have an system value
  2. a fixedObservation.valueQuantity.code = 'kg/m2'

Fixed Value: 3 elements

Slices

This structure defines the following Slices:

  • The element Observation.code.coding is sliced based on the value of value:code

Differential View

This structure is derived from Vital Signs Profile.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*FHIR Body Mass Index (BMI) Profile
... code 1..1CodeableConceptBody Mass Index (BMI)
.... coding CodingSlice: Unordered, Open by value:code
.... coding 0..*Coding
..... system 0..1uriFixed Value: http://loinc.org
..... code 0..1codeFixed Value: 39156-5
... valueQuantity 0..1Quantity
.... code 1..1codeFixed Value: kg/m2

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*FHIR Body Mass Index (BMI) Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration), Reference(MedicationDispense), Reference(MedicationStatement), Reference(Procedure), Reference(Immunization), Reference(ImagingStudy)Part of referenced event
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category SI1..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
... code SΣ1..1CodeableConceptBody Mass Index (BMI)
Binding: Vital Signs (extensible)
.... id 0..1stringxml:id (or equivalent in JSON)
.... coding ΣCodingCode defined by a terminology system
Slice: Unordered, Open by value:code
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... system Σ0..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ0..1codeSymbol in syntax defined by the system
Fixed Value: 39156-5
..... display Σ0..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(Patient)Who and/or what this is about
... context 0..1Reference(Encounter), Reference(EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] SΣI1..1dateTime, PeriodOften just a dateTime for Vital Signs
vs-1: Datetime must be at least to day.
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner), Reference(PractitionerRole), Reference(Organization), Reference(CareTeam), Reference(Patient), Reference(RelatedPerson)Who is responsible for the observation
... valueQuantity SΣI0..1QuantityVital Sign Value recorded with UCUM
Binding: Vital Signs Units (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... value SΣ1..1decimalNumerical value (with implicit precision)
.... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
.... unit SΣ1..1stringUnit representation
.... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
.... code SΣ1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: kg/m2
... dataAbsentReason SI0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device), Reference(DeviceComponent), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember SΣ0..*Reference(VitalSigns)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference), Reference(ImagingStudy), Reference(Media), Reference(QuestionnaireResponse), Reference(Observation), Reference(Sequence)Related measurements the observation is made from
... component SΣI0..*BackboneElementUsed when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code SΣ1..1CodeableConceptType of component observation (code / type)
Binding: Vital Signs (extensible)
.... valueQuantity SΣ0..1QuantityVital Sign Value recorded with UCUM
Binding: Vital Signs Units (required)
..... id 0..1stringxml:id (or equivalent in JSON)
..... value SΣ1..1decimalNumerical value (with implicit precision)
..... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit SΣ1..1stringUnit representation
..... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ1..1codeCoded responses from the common UCUM units for vital signs value set.
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

XML Template

<!-- Vital Signs Profile -->doco

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- 0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!-- 0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!-- 0..1 Language of the resource content  -->
 <text><!-- 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- 0..* Identifier 
     Business Identifier for observation --></identifier>
 <basedOn><!-- 0..* Reference(CarePlan)|Reference(DeviceRequest)|Reference(ImmunizationRecommendation)|Reference(MedicationRequest)|
   Reference(NutritionOrder)|Reference(ServiceRequest) Fulfills plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration)|Reference(MedicationDispense)|Reference(MedicationStatement)|Reference(Procedure)|Reference(Immunization)|
   Reference(ImagingStudy) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended +  -->
 <category><!-- ?? 1..* CodeableConcept Classification of  type of observation  --></category>
 <code> 1..1 CodeableConcept  <!-- 1..1 Body Mass Index (BMI) -->
  <-- coding sliced by value:code  in the specified orderOpen-->
  <coding> 0..* Coding  <!-- 0..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- 0..1 Identity of the terminology system -->
   <version value="[string]"/><!-- 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- 0..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!-- 0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!-- 0..1 If this coding was chosen directly by the user -->
  </coding>
  <text value="[string]"/><!-- 0..1 Plain text representation of the concept -->
 </code>
 <subject><!-- 1..1 Reference(Patient) Who and/or what this is about --></subject>
 <context><!-- 0..1 Reference(Encounter)|Reference(EpisodeOfCare) 
     Healthcare event during which this observation is made --></context>
 <effective[x]><!-- ?? 1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!-- 0..1 Date/Time this version was made available -->
 <performer><!-- 0..* Reference(Practitioner)|Reference(PractitionerRole)|Reference(Organization)|Reference(CareTeam)|
   Reference(Patient)|Reference(RelatedPerson) Who is responsible for the observation --></performer>
 <valueQuantity> 0..1 Quantity  <!-- 0..1 Vital Sign Value recorded with UCUM -->
  <value value="[decimal]"/><!-- 1..1 Numerical value (with implicit precision) -->
  <comparator value="[code]"/><!-- 0..1 < | <= | >= | > - how to understand the value  -->
  <unit value="[string]"/><!-- 1..1 Unit representation -->
  <system value="[uri]"/><!-- 1..1 System that defines coded unit form -->
  <code value="[code]"/><!-- 1..1 
      Coded responses from the common UCUM units for vital signs value set. -->
 </valueQuantity>
 <dataAbsentReason><!-- 0..1 CodeableConcept Why the result is missing  --></dataAbsentReason>
 <interpretation><!-- 0..1 CodeableConcept High, low, normal, etc.  --></interpretation>
 <comment value="[string]"/><!-- 0..1 Comments about result -->
 <bodySite><!-- 0..1 CodeableConcept Observed body part  --></bodySite>
 <method><!-- 0..1 CodeableConcept How it was done  --></method>
 <specimen><!-- 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- 0..1 Reference(Device)|Reference(DeviceComponent)|Reference(DeviceMetric) 
     (Measurement) Device --></device>
 <referenceRange> ?? 0..* BackboneElement  <!-- ?? 0..* Provides guide for interpretation -->
  <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
  <low><!-- 0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!-- 0..1 Quantity 
      High Range, if relevant --></high>
  <type><!-- 0..1 CodeableConcept Reference range qualifier  --></type>
  <appliesTo><!-- 0..* CodeableConcept Reference range population  --></appliesTo>
  <age><!-- 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[string]"/><!-- 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- 0..* Reference(Vital Signs Profile) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- 0..* Reference(DocumentReference)|Reference(ImagingStudy)|Reference(Media)|Reference(QuestionnaireResponse)|
   Reference(Observation)|Reference(Sequence) Related measurements the observation is made from --></derivedFrom>
 <component> ?? 0..* BackboneElement  <!-- ?? 0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!-- 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
  <code><!-- 1..1 CodeableConcept Type of component observation (code / type)  --></code>
  <valueQuantity> 0..1 Quantity  <!-- 0..1 Vital Sign Value recorded with UCUM -->
   <value value="[decimal]"/><!-- 1..1 Numerical value (with implicit precision) -->
   <comparator value="[code]"/><!-- 0..1 < | <= | >= | > - how to understand the value  -->
   <unit value="[string]"/><!-- 1..1 Unit representation -->
   <system value="[uri]"/><!-- 1..1 System that defines coded unit form -->
   <code value="[code]"/><!-- 1..1 
       Coded responses from the common UCUM units for vital signs value set. -->
  </valueQuantity>
  <dataAbsentReason><!-- 0..1 CodeableConcept Why the component result is missing  --></dataAbsentReason>
  <interpretation><!-- 0..1 CodeableConcept High, low, normal, etc.  --></interpretation>
  <referenceRange><!-- See #Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

JSON Template

{ // Vital Signs Profile
  // from Element: extension
    "meta" : { Meta }, //Metadata about the resource
    "implicitRules" : "<uri>", //A set of rules under which this content was created
    "language" : "<code>", //Language of the resource content 
    "text" : { Narrative }, //Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], //Extensions that cannot be ignored
    "identifier" : [{ Identifier }], //Business Identifier for observation
// value[x]: Fulfills plan, proposal or order. One of these 6:
    "basedOn" : [{ Reference(CarePlan) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(DeviceRequest) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(ImmunizationRecommendation) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(MedicationRequest) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(NutritionOrder) }], //Fulfills plan, proposal or order
    "basedOn" : [{ Reference(ServiceRequest) }], //Fulfills plan, proposal or order
// value[x]: Part of referenced event. One of these 6:
    "partOf" : [{ Reference(MedicationAdministration) }], //Part of referenced event
    "partOf" : [{ Reference(MedicationDispense) }], //Part of referenced event
    "partOf" : [{ Reference(MedicationStatement) }], //Part of referenced event
    "partOf" : [{ Reference(Procedure) }], //Part of referenced event
    "partOf" : [{ Reference(Immunization) }], //Part of referenced event
    "partOf" : [{ Reference(ImagingStudy) }], //Part of referenced event
    "status" : "<code>", // R! registered | preliminary | final | amended + 
    "category" : [{ CodeableConcept }], // C? R! Classification of  type of observation 
    "code" : { CodeableConcept }, // R! Body Mass Index (BMI) 
    "subject" : { Reference(Patient) }, // R! Who and/or what this is about
// value[x]: Healthcare event during which this observation is made. One of these 2:
    "context" : { Reference(Encounter) }, //Healthcare event during which this observation is made
    "context" : { Reference(EpisodeOfCare) }, //Healthcare event during which this observation is made
// value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // C? R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // C? R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", //Date/Time this version was made available
// value[x]: Who is responsible for the observation. One of these 6:
    "performer" : [{ Reference(Practitioner) }] //Who is responsible for the observation
    "performer" : [{ Reference(PractitionerRole) }], //Who is responsible for the observation
    "performer" : [{ Reference(Organization) }], //Who is responsible for the observation
    "performer" : [{ Reference(CareTeam) }], //Who is responsible for the observation
    "performer" : [{ Reference(Patient) }], //Who is responsible for the observation
    "performer" : [{ Reference(RelatedPerson) }], //Who is responsible for the observation
    "valueQuantity" : { Quantity }, //Vital Sign Value recorded with UCUM 
    "dataAbsentReason" : { CodeableConcept }, //Why the result is missing 
    "interpretation" : { CodeableConcept }, //High, low, normal, etc. 
    "comment" : "<string>", //Comments about result
    "bodySite" : { CodeableConcept }, //Observed body part 
    "method" : { CodeableConcept }, //How it was done 
    "specimen" : { Reference(Specimen) }, //Specimen used for this observation
// value[x]: (Measurement) Device. One of these 3:
    "device" : { Reference(Device) }, //(Measurement) Device
    "device" : { Reference(DeviceComponent) }, //(Measurement) Device
    "device" : { Reference(DeviceMetric) }, //(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(vitalsigns) }], //Used when reporting vital signs panel components
// value[x]: Related measurements the observation is made from. One of these 6:
    "derivedFrom" : [{ Reference(DocumentReference) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(ImagingStudy) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Media) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(QuestionnaireResponse) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Observation) }], //Related measurements the observation is made from
    "derivedFrom" : [{ Reference(Sequence) }], //Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }

 

Alternate definitions: Master Definition (XML, JSON), Schematron

10.1.18.67.4 Terminology Bindings

PathNameConformanceValueSet
Observation.languageCommon LanguagesextensibleCommon Languages
Observation.statusObservationStatusrequiredObservationStatus
Observation.categoryObservation Category CodespreferredObservation Category Codes
Observation.codeVital SignsextensibleVital Signs
Observation.valueQuantityVital Signs UnitsrequiredVital Signs Units
Observation.valueQuantity.comparatorQuantityComparatorrequiredQuantityComparator
Observation.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes
Observation.bodySiteSNOMED CT Body StructuresexampleSNOMED CT Body Structures
Observation.methodObservation MethodsexampleObservation Methods
Observation.referenceRange.typeObservation Reference Range Meaning CodesextensibleObservation Reference Range Meaning Codes
Observation.referenceRange.appliesToObservation Reference Range Applies To CodesexampleObservation Reference Range Applies To Codes
Observation.component.codeVital SignsextensibleVital Signs
Observation.component.valueQuantityVital Signs UnitsrequiredVital Signs Units
Observation.component.valueQuantity.comparatorQuantityComparatorrequiredQuantityComparator
Observation.component.dataAbsentReasonObservation Value Absent ReasonextensibleObservation Value Absent Reason
Observation.component.interpretationObservation Interpretation CodesextensibleObservation Interpretation Codes

10.1.18.67.5 Constraints

IdPathDetailsRequirements
vs-4Observation.categoryMust have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
Expression : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()
vs-1Observation.effective[x]Datetime must be at least to day.
Expression : ($this as dateTime).toString().length() >= 8
obs-3Observation.referenceRangeMust have at least a low or a high or text
Expression : low.exists() or high.exists() or text.exists()
vs-3Observation.componentIf there is no a value a data absent reason must be present
Expression : value.exists() or dataAbsentReason.exists()
.