Summary

10.1.18.79.2 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= '85353-1'
   • 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. No value in Observation.value[x]
3. At Least one Vitals Sign Observation reference in Observation.hasMember

Mandatory: 1 element
Must-Support: 1 element
Fixed Value: 2 elements
Prohibited: 1 element

Slices

This structure defines the following Slices:

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

<!-- Vital Signs Profile -->

<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) Fulfills plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended +   -->
 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <category> 1..1 CodeableConcept  <!-- 1..1 Classification of  type of observation -->
  <coding> 1..* Coding  <!-- 1..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- 1..1 Identity of the terminology system -->
   <version value="[string]"/><!-- 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- 1..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 -->
 </category>
 <code> 1..1 CodeableConcept  <!-- 1..1 Vital Signs Panel -->
  <-- coding sliced by value:code, value:system  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>
 <focus><!-- 0..1 Reference(Resource) The "focal point" of the observation --></focus>
 <context><!-- 0..1 Reference(Encounter) 
     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) 
     Who is responsible for the observation --></performer>
 <value[x]><!-- 0..0 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period 
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. --></value[x]>
 <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) (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><!-- 1..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- 0..* Reference(DocumentReference) 
     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>
  <value[x]><!-- 0..1 Quantity|CodeableConcept|string|
    boolean|integer|Range|Ratio|SampledData|time|dateTime|Period Vital Sign Value recorded with UCUM   --></value[x]>
  <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
    "basedOn" : [{ Reference(CarePlan) }], //Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], //Part of referenced event
    "status" : "<code>", // R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // R! Code defined by a terminology system
        "text" : "<string>" //Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // R! Vital Signs Panel
    "subject" : { Reference(Patient) }, // R! Who and/or what this is about
    "focus" : { Reference(Resource) }, //The "focal point" of the observation
    "context" : { Reference(Encounter) }, //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
    "performer" : [{ Reference(Practitioner) }], //Who is responsible for the observation
// value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 11:
    "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
    "device" : { Reference(Device) }, //(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // R! Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], //Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }

Summary

10.1.18.79.3 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= '85353-1'
   • 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. No value in Observation.value[x]
3. At Least one Vitals Sign Observation reference in Observation.hasMember

Mandatory: 1 element
Must-Support: 1 element
Fixed Value: 2 elements
Prohibited: 1 element

Slices

This structure defines the following Slices:

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

<!-- Vital Signs Profile -->

<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) Fulfills plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended +   -->
 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <category> 1..1 CodeableConcept  <!-- 1..1 Classification of  type of observation -->
  <coding> 1..* Coding  <!-- 1..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- 1..1 Identity of the terminology system -->
   <version value="[string]"/><!-- 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- 1..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 -->
 </category>
 <code> 1..1 CodeableConcept  <!-- 1..1 Vital Signs Panel -->
  <-- coding sliced by value:code, value:system  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>
 <focus><!-- 0..1 Reference(Resource) The "focal point" of the observation --></focus>
 <context><!-- 0..1 Reference(Encounter) 
     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) 
     Who is responsible for the observation --></performer>
 <value[x]><!-- 0..0 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period 
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. --></value[x]>
 <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) (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><!-- 1..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- 0..* Reference(DocumentReference) 
     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>
  <value[x]><!-- 0..1 Quantity|CodeableConcept|string|
    boolean|integer|Range|Ratio|SampledData|time|dateTime|Period Vital Sign Value recorded with UCUM   --></value[x]>
  <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
    "basedOn" : [{ Reference(CarePlan) }], //Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], //Part of referenced event
    "status" : "<code>", // R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // R! Code defined by a terminology system
        "text" : "<string>" //Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // R! Vital Signs Panel
    "subject" : { Reference(Patient) }, // R! Who and/or what this is about
    "focus" : { Reference(Resource) }, //The "focal point" of the observation
    "context" : { Reference(Encounter) }, //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
    "performer" : [{ Reference(Practitioner) }], //Who is responsible for the observation
// value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 11:
    "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
    "device" : { Reference(Device) }, //(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // R! Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], //Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }