Purpose

SDOHCC Observation Screening Response (OSR) is intended to represent question-answer pairs from Social Determinants of Health (SDOH) assessment instruments. An OSR that identifies a social risk or need can be referenced as evidence for an SDOHCC Condition. Additionally, an OSR may be addressed by, or be the outcome of, an SDOHCC Goal, or the reason for an SDOHCC ServiceRequest or SDOHCC Procedure. See the Data Modeling Framework for more detail on the relationships between OSR and other profiles in this IG.

This IG focuses on a workflow where completed assessment instruments are captured using QuestionnaireResponse. To facilitate querying and searching, individual question-answer pairs from a QuestionnaireResponse can be converted into Observations. The decision as to which responses from a QuestionnaireResponse to convert into Observations will generally be driven by the usage need. For more information on this topic see Representing Assessment Instrument Data in a FHIR Format.

In the future, for standardized assessment instruments, a StructureMap instance would ideally be provided by a Questionnaire steward to ensure consistency in the Observations and Conditions (i.e., unconfirmed health concerns) generated from the assessment instrument. For more information on this topic, see Using StructureMap to Generate Observations or Conditions from QuestionnaireResponse.

Usage

Observation.code has bindings to US Core Survey Codes (required) and Observation.value has bindings to LOINCCodes (preferred). Observation.code and Observation.value also have additional bindings to SDOH domain-specific value sets (e.g., for Food Insecurity, Inadequate Housing, etc.) which are determined by the value selected for Observation.category. If Observation.category references only one value from SDOHCC ValueSet SDOH Category (e.g., food-insecurity), Observation.code and Observation.value SHALL be selected from the corresponding domain-specific value set found in Additional Bindings. If more than one value is selected from SDOHCC ValueSet SDOH Category (e.g., food-insecurity and financial-insecurity) for Observation.category, then Observation.code and Observation.value SHALL be selected from one of the corresponding domain-specific value sets found in Additional Bindings (e.g. Food Insecurity Screening Assessments And Questions for Observation.code and Food Insecurity Screening Assessments Answers for Observation.value).

Occasionally, questions that are reused across different assessment instruments are represented by the same LOINC code, but the question’s allowed answer set may vary on different assessment instruments. Therefore, the allowed answer set (for Observation.value) for a question (Observation.code) is determined by the assessment instrument. For this reason, Gravity provides downloadable Assessment Instrument Spreadsheets that link Gravity-vetted questions to the assessment instruments from which they were chosen and their allowed answer sets. For access to the Spreadsheets and more information on this topic, see Social Risk Terminology Value Sets on the Gravity Confluence site and specifically the Assessment Instruments Spreadsheet Guidance document.

Of note, Gravity Project is continuously developing terminology for new SDOH domains. Sometimes a new SDOH domain may already be represented by a category code in SDOHCC ValueSet SDOH Category, but a domain-specific value set may not yet be available in VSAC. In this case, the Additional Binding for the new SDOH domain/category is the default binding for the profile element. Additionally, sometimes a domain-specific value set for a new domain is available in VSAC but does not yet include all standardized codes identified during the domain’s terminology development cycle. In this case, the value set’s “Description” tab in VSAC will state, “In progress”. If a domain-specific value set is available in VSAC but does not yet include all standardized codes identified during the domain’s terminology development cycle, the value set’s VSAC “Description” tab will state, “In progress”. Additional information related to Gravity value sets is provided on the Social Risk Terminology Value Sets page on the Gravity Project Confluence site.

Additionally, 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, if desired, Observation.category.text can also be used 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. For Observation.category: sdoh-category-unspecified, there will not be domain-specific value sets and Additional Bindings for Observation.code and Observation.value will be the default bindings to US Core Survey Codes (required) and LOINCCodes (preferred) respectively.

For more information on the correlation between Observation.category and the domain-specific value sets in Additional Bindings for Observation.code and Observation.value, see Gravity Project Value Sets.

When Observation.category is used to tag Observations by SDOH domain (e.g., Food Insecurity, Housing Instability), Observation.interpretation: POS (Positive) can be used to flag Observations that might represent a health-related social need (HRSN) in the specified SDOH domain(s) (see SDOHCC Observation Response Hunger Vital Sign Question 3 Example). For more information on the use of Observation.category and Observation.interpretation and their interplay when used with OSR, see Additional Guidance on SDOHCC Observation Screening Response Elements.

Observation can also reference other artifacts. For example:

• If a question-answer pair is not answered directly on an assessment instrument (e.g., when a score or value is based on other question-answer pairs), OSR can reference one or more other OSRs via Observation.derivedFrom (see SDOHCC Observation Response NHANES Question 6 Example).
• If assessment instrument context is needed, Observations generated from a QuestionnaireResponse can reference QuestionnaireResponse via Observation.derivedFrom.
• In addition to representing instances of question-answer pairs, SDOHCC Observation Screening Response can be used as an Observation Grouping that, via Observation.member, references the OSR instances that result from a completed assessment instrument. For this reason, in addition to codes that represent questions, the value sets bound to Observation.code include codes that represent assessment instruments (LOINC panel codes). For an Observation Grouping, Observation.code SHALL be a LOINC panel code and Observation.member SHALL reference the OSR instances generated from that LOINC panel (assessment instrument). Observation Grouping is most useful when additional assessment instrument context is needed and a QuestionnaireResponse has not been created. For more information on Observation Grouping, see Using Observation Screening Response to Group Observations.

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

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations 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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required) ele-1: All FHIR elements must have a @value or children
Slices for category	S	2..*	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:survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children 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:screening-assessment	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreScreeningAssessmentObservationCategory (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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
effective[x]	SΣC	1..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children us-core-1: Datetime must be at least to day.
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
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set. ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. ele-1: All FHIR elements must have a @value or children
Slices for hasMember	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0))	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument ele-1: All FHIR elements must have a @value or children
Slices for derivedFrom	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0))	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that 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 / Code	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:screening-assessment	required	USCoreScreeningAssessmentObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-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	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	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

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-1	error	Observation.effective[x]	Datetime must be at least to day. : $this is dateTime implies $this.toString().length() >= 10
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())
us-core-3	error	Observation.value[x], Observation.value[x]:valueQuantity, Observation.value[x]:valueCodeableConcept	SHALL use UCUM for coded quantity units. : ofType(Quantity).system.empty() or ofType(Quantity).system = 'http://unitsofmeasure.org'

This structure is derived from USCoreObservationScreeningAssessmentProfile

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations SDOH-Obs-4: At least one Observation.category SHALL be sdoh
status		1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
category		2..*	CodeableConcept	Classification of type of observation
Slices for category				Content/Rules for all slices
category:screening-assessment	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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified
subject		1..1	Reference(US Core Patient Profile(7.0.0))	Who and/or what the observation is about
effective[x]		1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
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
Slices for value[x]		0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified
bodySite		0..0
specimen		0..0
Slices for hasMember		0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0) | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	S	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom		0..*	Reference(US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | US Core Observation Screening Assessment Profile(7.0.0))	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes 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()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations 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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category	S	2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
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:screening-assessment	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreScreeningAssessmentObservationCategory (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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	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]	SΣC	1..1		Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day.
effectiveDateTime			dateTime S
effectivePeriod			Period
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
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this us-core-3: SHALL use UCUM for coded quantity units.
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity S	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set. us-core-3: SHALL use UCUM for coded quantity units.
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept S	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified us-core-3: SHALL use UCUM for coded quantity units.
dataAbsentReason	SC	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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
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
Slices for hasMember	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0) S | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | US Core Observation Screening Assessment Profile(7.0.0) S)	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that 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 / Code	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:screening-assessment	required	USCoreScreeningAssessmentObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-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	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	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.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-1	error	Observation.effective[x]	Datetime must be at least to day. : $this is dateTime implies $this.toString().length() >= 10
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())
us-core-3	error	Observation.value[x], Observation.value[x]:valueQuantity, Observation.value[x]:valueCodeableConcept	SHALL use UCUM for coded quantity units. : ofType(Quantity).system.empty() or ofType(Quantity).system = 'http://unitsofmeasure.org'

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations 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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required) ele-1: All FHIR elements must have a @value or children
Slices for category	S	2..*	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:survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ele-1: All FHIR elements must have a @value or children 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:screening-assessment	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreScreeningAssessmentObservationCategory (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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
effective[x]	SΣC	1..1		Clinically relevant time/time-period for observation ele-1: All FHIR elements must have a @value or children us-core-1: Datetime must be at least to day.
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
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set. ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified ele-1: All FHIR elements must have a @value or children us-core-3: SHALL use UCUM for coded quantity units.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. ele-1: All FHIR elements must have a @value or children
Slices for hasMember	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0))	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument ele-1: All FHIR elements must have a @value or children
Slices for derivedFrom	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0))	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that 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 / Code	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:screening-assessment	required	USCoreScreeningAssessmentObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-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	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	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

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-1	error	Observation.effective[x]	Datetime must be at least to day. : $this is dateTime implies $this.toString().length() >= 10
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())
us-core-3	error	Observation.value[x], Observation.value[x]:valueQuantity, Observation.value[x]:valueCodeableConcept	SHALL use UCUM for coded quantity units. : ofType(Quantity).system.empty() or ofType(Quantity).system = 'http://unitsofmeasure.org'

Differential View

This structure is derived from USCoreObservationScreeningAssessmentProfile

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations SDOH-Obs-4: At least one Observation.category SHALL be sdoh
status		1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
category		2..*	CodeableConcept	Classification of type of observation
Slices for category				Content/Rules for all slices
category:screening-assessment	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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified
subject		1..1	Reference(US Core Patient Profile(7.0.0))	Who and/or what the observation is about
effective[x]		1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
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
Slices for value[x]		0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified
bodySite		0..0
specimen		0..0
Slices for hasMember		0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0) | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	S	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom		0..*	Reference(US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | US Core Observation Screening Assessment Profile(7.0.0))	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category:SDOHCC	required	SDOHCCValueSetSDOHCategory http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory from this IG
Observation.code	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes 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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	USCoreObservationScreeningAssessmentProfile(7.0.0)	SDOH screening questionnaire observations 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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category	S	2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
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:screening-assessment	SC	1..*	CodeableConcept	Requires at least a category code 'sdoh' Binding: USCoreScreeningAssessmentObservationCategory (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: USCoreSurveyCodes (7.0.0) (required): Codes identifying names of simple observations. Additional Bindings Purpose Usage Digital Access Screening Assessments And Questions Extensible Observation.category = digital-access USCoreSurveyCodes (7.0.0) Required Observation.category = digital-literacy Less Than High School Education Screening Assessments And Questions Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments And Questions Extensible Observation.category = elder-abuse Unemployment Screening Assessments And Questions Extensible Observation.category = employment-status Financial Insecurity Screening Assessments And Questions Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments And Questions Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments And Questions Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments And Questions Extensible Observation.category = homelessness Housing Instability Screening Assessments And Questions Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments And Questions Extensible Observation.category = inadequate-housing USCoreSurveyCodes (7.0.0) Required Observation.category = incarceration-status Intimate Partner Violence Screening Assessments And Questions Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.272 Extensible Observation.category = language-access Material Hardship Screening Assessments And Questions Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments And Questions Extensible Observation.category = medical-cost-burden Health Literacy Screening Assessments And Questions Extensible Observation.category = personal-health-literacy Social Connection Screening Assessments And Questions Extensible Observation.category = social-connection Stress Screening Assessments And Questions Extensible Observation.category = stress Transportation Insecurity Screening Assessments And Questions Extensible Observation.category = transportation-insecurity Utility Insecurity Screening Assessments And Questions Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments And Questions Extensible Observation.category = veteran-status USCoreSurveyCodes (7.0.0) Required Observation.category = sdoh-category-unspecified
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	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]	SΣC	1..1		Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day.
effectiveDateTime			dateTime S
effectivePeriod			Period
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
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this us-core-3: SHALL use UCUM for coded quantity units.
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept S
valueString			string S
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity S	Actual result Binding: UnitsOfMeasureCaseSensitive (3.0.0) (required): This is the entire UCUM code set. us-core-3: SHALL use UCUM for coded quantity units.
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept S	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes Additional Bindings Purpose Usage Digital Access Screening Assessments Answers Extensible Observation.category = digital-access LOINCCodes Preferred Observation.category = digital-literacy Less Than High School Education Screening Assessments Answers Extensible Observation.category = educational-attainment Elder Abuse Screening Assessments Answers Extensible Observation.category = elder-abuse Unemployment Screening Assessments Answers Extensible Observation.category = employment-status Financial Insecurity Screening Assessments Answers Extensible Observation.category = financial-insecurity Food Insecurity Screening Assessments Answers Extensible Observation.category = food-insecurity Health Insurance Coverage Status Screening Assessments Answers Extensible Observation.category = health-insurance-coverage-status Homelessness Screening Assessments Answers Extensible Observation.category = homelessness Housing Instability Screening Assessments Answers Extensible Observation.category = housing-instability Inadequate Housing Screening Assessments Answers Extensible Observation.category = inadequate-housing LOINCCodes Preferred Observation.category = incarceration-status Intimate Partner Violence Screening Assessments Answers Extensible Observation.category = intimate-partner-violence VSAC 2.16.840.1.113762.1.4.1247.271 Extensible Observation.category = language-access Material Hardship Screening Assessments Answers Extensible Observation.category = material-hardship Medical Cost Burden Screening Assessments Answers Extensible Observation.category = medical-cost-burden HealthLiteracyScreeningAssessmentsAnswers (20231205) Extensible Observation.category = personal-health-literacy SocialConnectionScreeningAssessmentsAnswers (20231205) Extensible Observation.category = social-connection Stress Screening Assessments Answers Extensible Observation.category = stress Transportation Insecurity Screening Assessments Answers Extensible Observation.category = transportation-insecurity UtilityInsecurityScreeningAssessmentsAnswers (20240524) Extensible Observation.category = utility-insecurity Veteran Status Screening Assessments Answers Extensible Observation.category = veteran-status LOINCCodes Preferred Observation.category = sdoh-category-unspecified us-core-3: SHALL use UCUM for coded quantity units.
dataAbsentReason	SC	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
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
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
Slices for hasMember	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile(7.0.0) S | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | US Core Observation Screening Assessment Profile(7.0.0) S)	ADDITIONAL USCDI: Related Observation(s) or other resource the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	Related questionnaire responses or observations that 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 / Code	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:survey	preferred	Pattern: survey http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:screening-assessment	required	USCoreScreeningAssessmentObservationCategory http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-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	required	USCoreSurveyCodes http://hl7.org/fhir/us/core/ValueSet/us-core-survey-codes|7.0.0
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM) http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive|3.0.0
Observation.value[x]:valueCodeableConcept	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.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-1	error	Observation.effective[x]	Datetime must be at least to day. : $this is dateTime implies $this.toString().length() >= 10
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())
us-core-3	error	Observation.value[x], Observation.value[x]:valueQuantity, Observation.value[x]:valueCodeableConcept	SHALL use UCUM for coded quantity units. : ofType(Quantity).system.empty() or ofType(Quantity).system = 'http://unitsofmeasure.org'

This structure is derived from USCoreObservationScreeningAssessmentProfile

Summary

Mandatory: 2 elements
Must-Support: 3 elements
Prohibited: 2 elements

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)
• SDOHCC Observation Screening Response (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse)
• 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)
• US Core Observation Screening Assessment Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment|7.0.0)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Observation.value[x]
• The element 1 is sliced based on the value of Observation.hasMember
• The element 1 is sliced based on the value of Observation.derivedFrom

Maturity: 2