Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for clinical tests or diagnostic imaging results for a patient.
• Record or update clinical tests or diagnostic imaging results belonging to a Patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Observation must have:

1. a status
2. a category code
3. a LOINC code, if available, which tells you what is being measured
4. a patient

Each Observation must support:

1. a time indicating when the measurement was taken
2. a result value
   • if the result value is a numeric quantity, a standard UCUM unit
3. a reason why the data is absent*

* see guidance below

Profile specific implementation guidance:

• Servers SHOULD use the base FHIR Observation Category Codes. The Observation.category element provides an efficient way of restricting search on observations to a given context such as procedure, exam or laboratory observations. Example searches are shown in the Quick Start section below. However, clients need to understand that data categorization is somewhat subjective. The categorization applied by the source may not align with the client’s expectations. Clients may find it more useful to use queries based on a specific code or set of codes or to perform additional client side filtering of query results.
• Additional codes that translate or map to the Observation code or category codes are allowed. For example:
  • providing both a local code and LOINC code
  • providing a more specific code , a SNOMED CT concept, or a system specific code.
• Systems SHOULD support Observation.effectivePeriod to accurately represent procedure tests that are collected over a period of time .
• *An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.
  • For further guidance see the Observation Grouping section in FHIR Specification.
  • Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
• *An Observation.component without a value, SHALL include a reason why the data is absent.
  • Systems that never provide a component observation without a component value are not required to support Observation.component.dataAbsentReason.
• See the General Guidance page for further guidance on using SNOMED and UCUM.
• See the LOINC scale type to FHIR data type mapping for guidance on which Observation.value[x] data type to use based on the LOINC Type of Scale.

• For a starter set of example clinical test LOINC codes, see Appendix B in U.S. Core Data for Interoperability (USCDI) Task Force 2021 HITAC Phase 3 Recommendations Report Letter.
• For representing laboratory test results, see the US Core Laboratory Result Observation Profile.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from RelatedPerson

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
active	S	1..1	boolean	Whether this related person's record is in active use
patient	S	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SC	0..*	CodeableConcept	The nature of the relationship
name	SC	0..*	HumanName	A name associated with the person
telecom	S	0..*	ContactPoint	A contact detail for the person
address	S	0..*	Address	Address where the related person can be contacted or visited
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-14	error	RelatedPerson	Either a name or a relationship SHALL be provided (or both) : name.exists() or relationship.exists()

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!SΣ	1..1	boolean	Whether this related person's record is in active use
patient	SΣ	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SΣC	0..*	CodeableConcept	The nature of the relationship Binding: PatientRelationshipType (preferred): The nature of the relationship between a patient and the related person.
name	SΣC	0..*	HumanName	A name associated with the person
telecom	SΣ	0..*	ContactPoint	A contact detail for the person
address	SΣ	0..*	Address	Address where the related person can be contacted or visited
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
RelatedPerson.relationship	preferred	PatientRelationshipType

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-14	error	RelatedPerson	Either a name or a relationship SHALL be provided (or both) : name.exists() or relationship.exists()

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	A human identifier for this person
active	?!SΣ	1..1	boolean	Whether this related person's record is in active use
patient	SΣ	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SΣC	0..*	CodeableConcept	The nature of the relationship Binding: PatientRelationshipType (preferred): The nature of the relationship between a patient and the related person.
name	SΣC	0..*	HumanName	A name associated with the person
telecom	SΣ	0..*	ContactPoint	A contact detail for the person
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the related person was born
address	SΣ	0..*	Address	Address where the related person can be contacted or visited
photo		0..*	Attachment	Image of the person
period		0..1	Period	Period of time that this relationship is considered valid
communication		0..*	BackboneElement	A language which may be used to communicate with about the patient's health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language		1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
preferred		0..1	boolean	Language preference indicator
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
RelatedPerson.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
RelatedPerson.relationship	preferred	PatientRelationshipType
RelatedPerson.gender	required	AdministrativeGender
RelatedPerson.communication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding

Differential View

This structure is derived from RelatedPerson

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
active	S	1..1	boolean	Whether this related person's record is in active use
patient	S	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SC	0..*	CodeableConcept	The nature of the relationship
name	SC	0..*	HumanName	A name associated with the person
telecom	S	0..*	ContactPoint	A contact detail for the person
address	S	0..*	Address	Address where the related person can be contacted or visited
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-14	error	RelatedPerson	Either a name or a relationship SHALL be provided (or both) : name.exists() or relationship.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
active	?!SΣ	1..1	boolean	Whether this related person's record is in active use
patient	SΣ	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SΣC	0..*	CodeableConcept	The nature of the relationship Binding: PatientRelationshipType (preferred): The nature of the relationship between a patient and the related person.
name	SΣC	0..*	HumanName	A name associated with the person
telecom	SΣ	0..*	ContactPoint	A contact detail for the person
address	SΣ	0..*	Address	Address where the related person can be contacted or visited
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
RelatedPerson.relationship	preferred	PatientRelationshipType

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-14	error	RelatedPerson	Either a name or a relationship SHALL be provided (or both) : name.exists() or relationship.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
RelatedPerson	C	0..*	RelatedPerson	A person that is related to a patient, but who is not a direct target of care us-core-14: Either a name or a relationship SHALL be provided (or both)
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	A human identifier for this person
active	?!SΣ	1..1	boolean	Whether this related person's record is in active use
patient	SΣ	1..1	Reference(US Core Patient Profile)	The patient this person is related to
relationship	SΣC	0..*	CodeableConcept	The nature of the relationship Binding: PatientRelationshipType (preferred): The nature of the relationship between a patient and the related person.
name	SΣC	0..*	HumanName	A name associated with the person
telecom	SΣ	0..*	ContactPoint	A contact detail for the person
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the related person was born
address	SΣ	0..*	Address	Address where the related person can be contacted or visited
photo		0..*	Attachment	Image of the person
period		0..1	Period	Period of time that this relationship is considered valid
communication		0..*	BackboneElement	A language which may be used to communicate with about the patient's health
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
language		1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
preferred		0..1	boolean	Language preference indicator
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
RelatedPerson.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
RelatedPerson.relationship	preferred	PatientRelationshipType
RelatedPerson.gender	required	AdministrativeGender
RelatedPerson.communication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding

This structure is derived from RelatedPerson

Summary

Mandatory: 1 element
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• The syntax used to describe the interactions is described here.
• See the General Requirements section for additional rules and expectations when a server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

1. SHALL support fetching a RelatedPerson using the _id search parameter:

   GET [base]/RelatedPerson/[id] or GET [base]/RelatedPerson?_id=[id]

   Example:

   1. GET [base]/RelatedPerson/shaw-niece
   2. GET [base]/RelatedPerson?_id=shaw-niece

   Implementation Notes: (how to search by the logical id of the resource)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the patient search parameter:

   GET [base]/RelatedPerson?patient={Type/}[id]

   Example:

   1. GET [base]/RelatedPerson?patient=1032702

   Implementation Notes: Fetches a bundle of all RelatedPerson resources for the specified patient (how to search by reference)

2. SHOULD support searching using the name search parameter:

   GET [base]/RelatedPerson?name=[string]

   Example:

   1. GET [base]/RelatedPerson?name=Mary Shaw

   Implementation Notes: Fetches a bundle of all RelatedPerson resources matching the name (how to search by string)