Purpose

SDOHCC Observation Assessment is intended for social risk-related Observations that involve an assessment (e.g., by a provider, payer, etc.) rather than being derived only from question-answer pairs on assessment instruments (as is the case for SDOHCC Observation Screening Response).

Usage

The Observation.category slice with binding to SDOHCC ValueSet SDOH Category allows categorization of the Observation into an SDOH category (domain). However, unlike SDOHCC Observation Screening Response, this profile does not have Gravity-vetted, preferred value sets in VSAC. This was intentional so as not to constrain the social risk observations that a provider might make about an individual.

Of note, Gravity Project is continuously developing terminology for new SDOH domains, and some SDOH domains may not yet be represented in SDOHCC ValueSet SDOH Category. In this case, Observation.category: sdoh-category-unspecified can be used and Observation.category.text can be added to further specify the domain. For example, at the time of publication of this IG, “disability-status” is not yet included in SDOHCC ValueSet SDOH Category. In this case, Observation.category: sdoh-category-unspecified can be used along with Observation.category.text: Disability Status.

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

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. ele-1: All FHIR elements must have a @value or children
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:us-core	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets ele-1: All FHIR elements must have a @value or children
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories. ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred) ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0) | Group)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
performer	SΣ	0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
value[x]	SΣC	0..1		Actual result ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from ele-1: All FHIR elements must have a @value or children
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	USCoreSimpleObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category|7.0.0
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
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()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

This structure is derived from USCoreSimpleObservationProfile

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
Slices for category				Content/Rules for all slices
category:us-core	C	1..*	CodeableConcept	Requires at least a category code 'sdoh'
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code		1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject		1..1	Reference(US Core Patient Profile(7.0.0) | Group)	Who and/or what the observation is about
effective[x]		0..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation
performer		0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation
derivedFrom		0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
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	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.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0) | Group)	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	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime S
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean S
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
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: ObservationMethods (example): Methods for simple observations.
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 obs-3: Must have at least a low or a high or text
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	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource 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	C	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

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	USCoreSimpleObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category|7.0.0
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG
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	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
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
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
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()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. ele-1: All FHIR elements must have a @value or children
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children
category:us-core	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets ele-1: All FHIR elements must have a @value or children
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories. ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred) ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0) | Group)	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
performer	SΣ	0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation ele-1: All FHIR elements must have a @value or children
value[x]	SΣC	0..1		Actual result ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from ele-1: All FHIR elements must have a @value or children
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	USCoreSimpleObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category|7.0.0
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
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()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

Differential View

This structure is derived from USCoreSimpleObservationProfile

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
Slices for category				Content/Rules for all slices
category:us-core	C	1..*	CodeableConcept	Requires at least a category code 'sdoh'
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code		1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject		1..1	Reference(US Core Patient Profile(7.0.0) | Group)	Who and/or what the observation is about
effective[x]		0..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation
performer		0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation
derivedFrom		0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreSimpleObservationProfile(7.0.0)	SDOH assessment observation obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present SDOH-Obs-4: At least one Observation.category SHALL be sdoh
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	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.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0) | Group)	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	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime S
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0))	Who is responsible for the observation
value[x]	SΣC	0..1		Actual result
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean S
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
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: ObservationMethods (example): Methods for simple observations.
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 obs-3: Must have at least a low or a high or text
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	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence)	ADDITIONAL USCDI: US Core Profiles or other resource 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	C	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

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	USCoreSimpleObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category|7.0.0
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	preferred	SDOHCCValueSetLOINCSNOMEDCT http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetLOINCSNOMEDCT from this IG
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	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
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
SDOH-Obs-4	error	Observation	At least one Observation.category SHALL be sdoh : category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()
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()
us-core-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())

This structure is derived from USCoreSimpleObservationProfile

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|7.0.0)
• SDOHCC PractitionerRole (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-practitionerrole)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0)
• US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam|7.0.0)
• US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|7.0.0)
• US Core QuestionnaireResponse Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|7.0.0)

Maturity: 2