Example Usage Scenarios:

The following are example usage scenarios for this Profile:

• Query for the documentation of a formal panel of assessment questions related to a patient's functioning and engagement.
• Record or update observations related to collections of assessment questions for a Patient.

Mandatory and Must Support Data Elements

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

Each Personal Functioning and Engagement Collection must have:

1. a status
2. a category code of "survey" and "functioning"
3. a code representing the specific panel
4. a patient
5. the point in time or period when the observation was made
6. who made the observation

Each Personal Functioning and Engagement Collection must support:

1. the location the observation was made
2. any devices the patient used
3. an additional category value or values specifying the specific health or health-related domain that this observation is related to***
4. related questionnaire responses that this observation is made from
5. references to nested collections or single questions that represent the answers within the panel* or a reason why the data is absent**

* ** *** see guidance below

Profile specific implementation guidance:

• *These collection observations represent structured instruments and panels with multiple questions. The hasMember element SHALL be used to point to child Observation instances that contain the specific questions and answers, represented by Single Observations or nested panels represented by this profile. The Observation.value and Observation.component elements SHALL be empty.
• **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. Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
• ***When a health or health-related domain is specified as an additional category value, Observation.code SHOULD be drawn from the corresponding domain-based value set as discussed below and on the domains page.

***Panel codes are not in scope for inclusion within domain-based value sets within STU1 of the PFE IG while the PACIO community determines how best to apply domains to panels that may have specific observations from multiple domains as descendents. In the meantime, the recommendation is not to include domain categories within Collection observation instances.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreSimpleObservationProfile	assessment observation Constraints: obs-6, obs-7
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used. Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	2..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code	SΣ	1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment. Binding: LOINCCodes (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what the observation is about
effective[x]	SΣ	1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime S
effectivePeriod			Period
performer	SΣ	1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
hasMember	SΣ	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	SΣ	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.code	preferred	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from USCoreSimpleObservationProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	USCoreSimpleObservationProfile	assessment observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
status		1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used.
category		2..*	CodeableConcept	(USCDI) Classification of type of observation
Slices for category				Content/Rules for all slices
category:us-core		1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code		1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment.
effective[x]		1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime
effectivePeriod			Period
performer		1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
value[x]		0..0
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
hasMember	S	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	S	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
component		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreSimpleObservationProfile	assessment observation Constraints: obs-6, obs-7
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used. Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	2..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code	SΣ	1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment. Binding: LOINCCodes (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime S
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
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
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	SΣ	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	SΣ	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.code	preferred	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreSimpleObservationProfile	assessment observation Constraints: obs-6, obs-7
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used. Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	2..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code	SΣ	1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment. Binding: LOINCCodes (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what the observation is about
effective[x]	SΣ	1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime S
effectivePeriod			Period
performer	SΣ	1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
hasMember	SΣ	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	SΣ	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.code	preferred	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Differential View

This structure is derived from USCoreSimpleObservationProfile

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	USCoreSimpleObservationProfile	assessment observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
status		1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used.
category		2..*	CodeableConcept	(USCDI) Classification of type of observation
Slices for category				Content/Rules for all slices
category:us-core		1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code		1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment.
effective[x]		1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime
effectivePeriod			Period
performer		1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
value[x]		0..0
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
hasMember	S	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	S	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
component		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreSimpleObservationProfile	assessment observation Constraints: obs-6, obs-7
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:event-location	S	0..1	Reference(US Core Location Profile(6.1.0))	An extension to indicate where the observation event occurred. URL: http://hl7.org/fhir/StructureDefinition/event-location profiled by http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
extension:device-use	S	0..*	Reference(Personal Functioning and Engagement Use of Device)	An extension to indicate a record of assistive device usage by a patient during an assessment. URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used. Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	2..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	1..2	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement US Core Value Set (required)
category:survey	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Survey Value Set (required)
category:PFEDomain	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Binding: Personal Functioning and Engagement Category Value Set (required)
code	SΣ	1..1	CodeableConcept	For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment. Binding: LOINCCodes (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(6.1.0))	(USCDI) Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinical relevant time for an assessment such as post-acute care observations performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).
effectiveDateTime			dateTime S
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	1..*	Reference(US Core Practitioner Profile(6.1.0) | US Core PractitionerRole Profile(6.1.0) | US Core Organization Profile(6.1.0))	The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: SDOHCC ValueSet Observation Method (example)
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
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
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	SΣ	0..*	Reference(Personal Functioning and Engagement Single Observation)	Each post-acute care observation in the collection. May also be another collection to support nested sections.
derivedFrom	SΣ	0..*	Reference(US Core QuestionnaireResponse Profile(6.1.0) | US Core Simple Observation Profile(6.1.0))	Should point back to the QuestionnaireResponse that this resource is derived from.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category From the FHIR Standard
Observation.category:us-core	required	PFEUSCoreCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-us-core-category-vs From this IG
Observation.category:survey	required	PFESurveyCategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-survey-category-vs From this IG
Observation.category:PFEDomain	required	PFECategoryVS http://hl7.org/fhir/us/pacio-pfe/ValueSet/pfe-category-vs From this IG
Observation.code	preferred	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	SDOHCCValueSetObservationMethod http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationMethod
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from USCoreSimpleObservationProfile

Summary

Mandatory: 4 elements
Must-Support: 6 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0)
• Personal Functioning and Engagement Single Observation (http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-observation-single)
• US Core QuestionnaireResponse Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0)
• US Core Simple Observation Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-simple-observation|6.1.0)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/event-location
• http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/device-patient-used

Maturity: 3

The syntax used to describe the interactions below is described here.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching using the combination of the patient and category search parameters:

   GET [base]/Observation?patient={Type/}[id]&category={system|}[code]

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|survey
   2. GET [base]/Observation?patient=1134281&category=http://hl7.org/fhir/sid/icf|mental_functions

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = survey or mental_functions respectively (how to search by reference and how to search by token)

2. SHALL support searching using the combination of the patient and code search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

   GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/Observation?patient=1134281&code=http://loinc.org|72133-2
   2. GET [base]/Observation?patient=1134281&code=http://loinc.org|72133-2,http://loinc.org|72107-6,http://loinc.org|54635-8

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple report codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)

3. SHALL support searching using the combination of the patient and category and date search parameters:
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Observation?patient=555580&category=http://terminology.hl7.org/CodeSystem/observation-category|survey&date=ge2018-03-14T00:00:00Z
   2. GET [base]Observation?patient=555580&category=http://hl7.org/fhir/sid/icf|mental_functions&date=ge2018-03-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = survey or mental_functions respectively (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and category and status search parameters:
   • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&status={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|survey&status=final
   2. GET [base]/Observation?patient=1134281&category=http://hl7.org/fhir/sid/icf|mental_functions&status=final

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category = survey or mental_functions respectively and status final (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and code and date search parameters:
   • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Observation?patient=555580&code=http://loinc.org|72133-2&date=ge2019-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)