Summary

10.1.25.2.2 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= '8867-4'
   • 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. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsentReason
   • Each Observation.valueQuantity must have:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code = '/min'

Mandatory: 3 elements (+4 nested mandatory elements)
Must-Support: 4 elements
Fixed Value: 4 elements

Slices

This structure defines the following Slices:

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

<!-- observation-heartrate -->

<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 Heart Rate -->
  <-- coding sliced by value:code, value:system  in the specified orderOpen-->
  <coding>  1..1 Coding  <!--  1..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 -->
 </code>
 <subject><!--  1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!--  0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!--  0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <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>
 <-- valueQuantity sliced by type:$this  in the specified orderClosed-->
 <valueQuantity>  0..1 Quantity  <!--  0..1 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 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..* CodeableConcept High, low, normal, etc.   --></interpretation>
 <note><!--  0..* Annotation Comments about the observation --></note>
 <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 even if unrecognized  --></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(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 even if unrecognized  --></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|Attachment Vital Sign Value recorded with UCUM   --></value[x]>
  <dataAbsentReason><!--  0..1 CodeableConcept Why the component result is missing   --></dataAbsentReason>
  <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
  <referenceRange><!-- See #Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

{ // observation-heartrate
  // from Element: extension
    "meta" : { Meta }, // C?Metadata about the resource
    "implicitRules" : "<uri>", // C?A set of rules under which this content was created
    "language" : "<code>", // C?Language of the resource content
    "text" : { Narrative }, // C?Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // C?Extensions that cannot be ignored
    "identifier" : [{ Identifier }], // C?Business Identifier for observation
    "basedOn" : [{ Reference(CarePlan) }], // C?Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], // C?Part of referenced event
    "status" : "<code>", // C? R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // C? R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // C? R! Code defined by a terminology system
        "text" : "<string>" // C?Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // C? R! Heart Rate
    "subject" : { Reference(Patient) }, // C? R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // C?What the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // C?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>", // C?Date/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // C?Who is responsible for the observation
    "valueQuantity" : [ //  sliced by type:$this  in the specified order, Closed 
      { // Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. // C?
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "value" : <decimal>, // C? R! Numerical value (with implicit precision)
        "comparator" : "<code>", // C?< | <= | >= | > - how to understand the value
        "unit" : "<string>", // C? R! Unit representation
        "system" : "http://unitsofmeasure.org", // C? R! 
        "code" : "/min" // C? R! 
      }
    ],
    "dataAbsentReason" : { CodeableConcept }, // C?Why the result is missing
    "interpretation" : [{ CodeableConcept }], // C?High, low, normal, etc.
    "note" : [{ Annotation }], // C?Comments about the observation
    "bodySite" : { CodeableConcept }, // C?Observed body part
    "method" : { CodeableConcept }, // C?How it was done
    "specimen" : { Reference(Specimen) }, // C?Specimen used for this observation
    "device" : { Reference(Device) }, // C?(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // C?Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // C?Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }

Summary

10.1.25.2.3 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= '8867-4'
   • 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. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsentReason
   • Each Observation.valueQuantity must have:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code = '/min'

Mandatory: 3 elements (+4 nested mandatory elements)
Must-Support: 4 elements
Fixed Value: 4 elements

Slices

This structure defines the following Slices:

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

<!-- observation-heartrate -->

<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 Heart Rate -->
  <-- coding sliced by value:code, value:system  in the specified orderOpen-->
  <coding>  1..1 Coding  <!--  1..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 -->
 </code>
 <subject><!--  1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!--  0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!--  0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <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>
 <-- valueQuantity sliced by type:$this  in the specified orderClosed-->
 <valueQuantity>  0..1 Quantity  <!--  0..1 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 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..* CodeableConcept High, low, normal, etc.   --></interpretation>
 <note><!--  0..* Annotation Comments about the observation --></note>
 <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 even if unrecognized  --></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(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 even if unrecognized  --></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|Attachment Vital Sign Value recorded with UCUM   --></value[x]>
  <dataAbsentReason><!--  0..1 CodeableConcept Why the component result is missing   --></dataAbsentReason>
  <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
  <referenceRange><!-- See #Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

{ // observation-heartrate
  // from Element: extension
    "meta" : { Meta }, // C?Metadata about the resource
    "implicitRules" : "<uri>", // C?A set of rules under which this content was created
    "language" : "<code>", // C?Language of the resource content
    "text" : { Narrative }, // C?Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // C?Extensions that cannot be ignored
    "identifier" : [{ Identifier }], // C?Business Identifier for observation
    "basedOn" : [{ Reference(CarePlan) }], // C?Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], // C?Part of referenced event
    "status" : "<code>", // C? R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // C? R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // C? R! Code defined by a terminology system
        "text" : "<string>" // C?Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // C? R! Heart Rate
    "subject" : { Reference(Patient) }, // C? R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // C?What the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // C?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>", // C?Date/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // C?Who is responsible for the observation
    "valueQuantity" : [ //  sliced by type:$this  in the specified order, Closed 
      { // Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. // C?
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "value" : <decimal>, // C? R! Numerical value (with implicit precision)
        "comparator" : "<code>", // C?< | <= | >= | > - how to understand the value
        "unit" : "<string>", // C? R! Unit representation
        "system" : "http://unitsofmeasure.org", // C? R! 
        "code" : "/min" // C? R! 
      }
    ],
    "dataAbsentReason" : { CodeableConcept }, // C?Why the result is missing
    "interpretation" : [{ CodeableConcept }], // C?High, low, normal, etc.
    "note" : [{ Annotation }], // C?Comments about the observation
    "bodySite" : { CodeableConcept }, // C?Observed body part
    "method" : { CodeableConcept }, // C?How it was done
    "specimen" : { Reference(Specimen) }, // C?Specimen used for this observation
    "device" : { Reference(Device) }, // C?(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // C?Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // C?Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }