Additional Guidance

The SDOHCC_Observation_ScreeningResponseBase_1 profile allows the representation of individual Question and Answer pairs (QA pairs) from an SDOH screening questionnaire as Observations. The Question and Answer pairs from the screening questionnaire are also represented using SDC Questionnaire and SDC QuestionnaireResponse.

Many of the resources/profiles used for SDOH reference one another. The current flow is that QuestionnaireResponses result in Observations that are used as evidence for Conditions that are addressed by Goals that lead to ServiceRequests and Procedures.

The sections that follow provide additional guidance on some elements in the SDOHCC_Observation_ScreeningResponseBase_1 profile.

Observation.category

To facilitate searching for SDOH screening response observations, Observation.category is sliced. The required slices are bound to the "social-history" and "survey" codes from the FHIR "Observation Category Codes" value set.

Additionally, an optional Observation.category slice bound to the "SDOHCC ValueSet SDOHDomain 1" value set allows the categorization of an Observation into one or more of the SDOH domains (e.g., food-insecurity-domain, inadequate-housing-domain, etc.). It is recommended that this optional slice be used in order to facilitate searching for SDOH observations.

Observation.code

Observation.code is currently bound to codes from the FHIR "LOINC Codes" value set with binding strength: Required. LOINC codes are required because Gravity intends to use only LOINC encoded Questionnaires to generate QuestionnaireResponses which, in turn, will generate Screening Response Observations. As the Gravity Project continues to refine content for the SDOH domains (e.g., food, housing, transportation etc.), the value set for Observation.code will be refined to LOINC codes that pertain to SDOH domains.

Observation.subject

Observation.subject is restricted to referencing Patient Resource.

Although the US Core Condition, CarePlan, Goal, and Procedure Profiles restrict Subject to US Core Patient Profile, US Core does not offer a generic Observation Profile. For this reason, SDOHCC_Observation_ScreeningResponseBase_1 does not restrict Observation.subject to US Core Patient Profile. However, if an implementer is creating US Core profiles (e.g., US Core Condition, US Core Procedure, etc.) that require US Core Patient for Subject, then US Core Patient should also be used for Subject in other profiles (e.g., Observation, ServiceRequest, etc.) which do not currently specify US Core Patient.

Observation.performer

Some SDOH QA pairs on a screening questionnaire are not answered directly (e.g., asserted) by the individual completing the questionnaire. Rather, some QA pairs (e.g., the Hunger Vital Sign 88124-3 "Food insecurity risk") may be derived from other QA pairs. For a ScreeningResponse Observation that is not answered directly, but rather derived from other QA pairs on a screener, Observation.performer should not be specified and Observation.derivedFrom should reference the relevant ScreeningResponse Observation(s).

Example: 88121-9 Hunger Vital Signs [HVS]

For the LOINC Hunger Vital Sign™ Panel, an answer of "often true" or "sometimes true" to either or both of the Hunger Vital Sign questions (88122-7 or 88123-5) identifies a patient as at risk for food insecurity (i.e., the answer for 88124-3 is "At risk", LA19952-3).

Thus, 88124-3 "Food insecurity risk" is not explicitly answered by the individual completing the questionnaire. In this case, Observation.performer should be left empty and Observation.derivedFrom should reference the Observations that represent the QA pairs for Hunger Vital Sign questions 88122-7 and 88123-5.

Observation.value and Observation.dataAbsentReason

Observation.value is currently bound to codes from the FHIR "LOINC Codes" value set. As the Gravity Project continues to refine content for the SDOH domains, the value set for Observation.value will be refined to the LOINC Normative Answer Lists for LOINC codes that address SDOH domains.

Of note, many LOINC Normative Answer Lists include codes that overlap with values in the FHIR value set for Observation.dataAbsentReason.

Example: LOINC code 82589-3

For LOINC code 82589-3 "What is the highest level of school that you have finished?", the Normative Answer List LL5351-3 includes "I choose not to answer this question". This LOINC answer code overlaps with "asked-declined" in the value set for Observation.dataAbsentReason.

However, some LOINC Normative Answer Lists do not include codes that overlap with values in the FHIR value set for Observation.dataAbsentReason.

Example: LOINC Code 76437-3

For LOINC Code 76437-3 "What is your main insurance?", the Normative Answer List does not include a code that overlaps with a code in the value set for Observation.dataAbsentReason (e.g., unknown, asked-declined, etc.).

If the LOINC Normative Answer List for a LOINC code offers an adequate code for why an Observation.value may not be known, it SHOULD be used as the value for Observation.value.

If the LOINC Normative Answer List for a LOINC code does not offer an adequate code for why an Observation.value may not be known, a code from Observation.dataAbsentReason SHOULD be used in lieu of Observation.value.

FHIR already has a rule that: dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty(). However, this means that Observation.value and Observation.dataAbsentReason are both optional elements since one or the other may be used. Therefore, a profile could validate without Observation.value and without Observation.dataAbsentReason. For this reason, the Gravity Observation profile has added the FHIRPath rule that: "either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided".

Observation.derivedFrom

Observation.derivedFrom is sliced to allow the preferred option of referencing the SDC QuestionnaireResponse Profile and/or the SDOHCC-Observation-ScreeningResponseBase-1 Profile.

Observation.derivedFrom should reference the SDC QuestionnaireResponse Profile and/or the SDOHCC-Observation-ScreeningResponseBase-1 Profile if they exist.

Additionally, Observation.derivedFrom may reference DocumentReference, Observation and/or QuestionnaireResponse.

Generally, Observation.derivedFrom will reference the SDC QuestionnaireResponse which, in turn, will reference the Questionnaire from which a QA pair in an Observation is derived.

However, some SDOH QA pairs (e.g., HVS 88124-3 "Food insecurity risk") are not answered directly (e.g., asserted) by the individual completing the screening questionnaire but rather are derived from other QA pairs on the screener. In that case, Observation.derivedFrom SHOULD also reference any relevant Screening Response Observations (using SDOHCC_Observation_ScreeningResponseBase_1).

Example: 88121-9 Hunger Vital Signs [HVS]

For the LOINC Hunger Vital Sign™ Panel, an answer of "often true" or "sometimes true" to either or both of the Hunger Vital Sign questions (88122-7 or 88123-5) identifies a patient as at risk for food insecurity (i.e., the answer for 88124-3 is "At risk", LA19952-3).

Thus, 88124-3 "Food insecurity risk" is not explicitly answered by the individual completing the questionnaire. Observation.derivedFrom should be used to reference the Observations that represent the QA pairs for Hunger Vital Sign questions 88122-7 and 88123-5.

• Text Summary
• Differential Table
• Snapshot Table
• Snapshot Table (Must Support)
• All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	I	0..*	Observation	Measurements and simple assertions SDOHCC-1: either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided
status	S	1..1	code	registered | preliminary | final | amended +
category		2..*	(Slice Definition)	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOHDomain	S	0..*	CodeableConcept	e.g., food-insecurity-domain | transportation-insecurity-domain Binding: SDOHCC ValueSet SDOHDomain 1 (required)
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)
subject	S	1..1	Reference(Patient)	Who and/or what the observation is about
effective[x]	S	1..1	(Slice Definition)	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectivePeriod		0..1	Period	Clinically relevant time/time-period for observation
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
performer	S	0..*	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	S	0..1	CodeableConcept	Actual result Binding: LOINCCodes (required)
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
derivedFrom	S	0..*	(Slice Definition)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation ScreeningResponseBase 1 | SDC Questionnaire Response)	Related measurements the observation is made from
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Observation	I	0..*	Observation	Measurements and simple assertions SDOHCC-1: either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided
id	Σ	0..1	string	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) Max Binding: AllLanguages: A human language.
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	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	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		2..*	(Slice Definition)	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOHDomain	S	0..*	CodeableConcept	e.g., food-insecurity-domain | transportation-insecurity-domain Binding: SDOHCC ValueSet SDOHDomain 1 (required)
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)
subject	SΣ	1..1	Reference(Patient)	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	(Slice Definition)	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectivePeriod	Σ	0..1	Period	Clinically relevant time/time-period for observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣI	1..1	dateTime	Starting time with inclusive boundary
end	SΣI	1..1	dateTime	End time with inclusive boundary, if not ongoing
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣI	0..1	CodeableConcept	Actual result Binding: LOINCCodes (required)
dataAbsentReason	SI	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	SΣ	0..*	(Slice Definition)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation ScreeningResponseBase 1 | SDC Questionnaire Response)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
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
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	I	0..1	CodeableConcept	Why the component 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.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Observation	I	0..*	Observation	Measurements and simple assertions SDOHCC-1: either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category:SocialHistory		1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey		1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOHDomain		0..*	CodeableConcept	e.g., food-insecurity-domain | transportation-insecurity-domain Binding: SDOHCC ValueSet SDOHDomain 1 (required)
code	Σ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)
subject	Σ	1..1	Reference(Patient)	Who and/or what the observation is about
effective[x]	Σ	1..1	(Slice Definition)	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectivePeriod	Σ	0..1	Period	Clinically relevant time/time-period for observation
start	ΣI	1..1	dateTime	Starting time with inclusive boundary
end	ΣI	1..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	ΣI	0..1	CodeableConcept	Actual result Binding: LOINCCodes (required)
dataAbsentReason	I	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
derivedFrom	Σ	0..*	(Slice Definition)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
derivedFrom:SupportedDerivedFrom	Σ	0..*	Reference(SDOHCC Observation ScreeningResponseBase 1 | SDC Questionnaire Response)	Related measurements the observation is made from
Documentation for this format

This structure is derived from Observation

Summary

Mandatory: 4 elements (2 nested mandatory elements)
Must-Support: 14 elements
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-Observation-ScreeningResponseBase-1
• http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the value of pattern:$this
• The element Observation.effective[x] is sliced based on the value of type:$this
• The element Observation.derivedFrom is sliced based on the value of profile:resolve()

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	I	0..*	Observation	Measurements and simple assertions SDOHCC-1: either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided
status	S	1..1	code	registered | preliminary | final | amended +
category		2..*	(Slice Definition)	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOHDomain	S	0..*	CodeableConcept	e.g., food-insecurity-domain | transportation-insecurity-domain Binding: SDOHCC ValueSet SDOHDomain 1 (required)
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)
subject	S	1..1	Reference(Patient)	Who and/or what the observation is about
effective[x]	S	1..1	(Slice Definition)	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectivePeriod		0..1	Period	Clinically relevant time/time-period for observation
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
performer	S	0..*	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	S	0..1	CodeableConcept	Actual result Binding: LOINCCodes (required)
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
derivedFrom	S	0..*	(Slice Definition)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation ScreeningResponseBase 1 | SDC Questionnaire Response)	Related measurements the observation is made from
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	I	0..*	Observation	Measurements and simple assertions SDOHCC-1: either Observation.valueCodableConcept or Observation.dataAbsentReason MUST be provided
id	Σ	0..1	string	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) Max Binding: AllLanguages: A human language.
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	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	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		2..*	(Slice Definition)	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOHDomain	S	0..*	CodeableConcept	e.g., food-insecurity-domain | transportation-insecurity-domain Binding: SDOHCC ValueSet SDOHDomain 1 (required)
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)
subject	SΣ	1..1	Reference(Patient)	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	(Slice Definition)	Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effective[x]:effectivePeriod	Σ	0..1	Period	Clinically relevant time/time-period for observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣI	1..1	dateTime	Starting time with inclusive boundary
end	SΣI	1..1	dateTime	End time with inclusive boundary, if not ongoing
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣI	0..1	CodeableConcept	Actual result Binding: LOINCCodes (required)
dataAbsentReason	SI	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	SΣ	0..*	(Slice Definition)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation ScreeningResponseBase 1 | SDC Questionnaire Response)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
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
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	I	0..1	CodeableConcept	Why the component 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.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format