Personal Health Device Implementation Guide
2.0.0-ballot - STU2 Ballot International flag

This page is part of the Personal Health Device FHIR IG (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) v4.3.0. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PhdCompoundNumericObservation - Detailed Descriptions

Draft as of 2017-06-02

Definitions for the PhdCompoundNumericObservation resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Observation
Definition

The PhdCompoundNumericObservation reports PHD measurements that contain one of either a Compound-Basic-Nu-Observed-Value, Compound-Simple-Nu-Observed-Value, or Compound-Nu-Observed-Value attribute.

Comments

Used for compound numeric observations from Personal Health Devices

2. Observation.category:VSCat
Slice NameVSCat
Control0..1
4. Observation.category:VSCat.coding
Control1..?
6. Observation.category:VSCat.coding.system
Control1..?
Fixed Valuehttp://terminology.hl7.org/CodeSystem/observation-category
8. Observation.category:VSCat.coding.code
Control1..?
Fixed Valuevital-signs
10. Observation.value[x]
Control0..0
12. Observation.dataAbsentReason
Definition

Provides a reason why no measurement compoundComponent elements are present. This situation only happens if the Measurement-Status attribute indicates a generic error.

Comments

Special values reported in the Compound-Basic/Simple-Nu-Observed-Value are handled individually in each compoundComponent element and are not considered generic. The Compound-Nu-Observed-Value has its own status entry and it is also handled in the component elements representing the compound.

14. Observation.dataAbsentReason.coding
Control1..?
SlicingThis element introduces a set of slices on Observation.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 16. Observation.dataAbsentReason.coding:FhirDefault
    Slice NameFhirDefault
    Control1..1
    18. Observation.dataAbsentReason.coding:FhirDefault.system
    Control1..?
    Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
    20. Observation.dataAbsentReason.coding:FhirDefault.code
    Control1..?
    22. Observation.component:compound
    Slice Namecompound
    Definition

    Each compoundComponent contains one of the N constituents of the compound measurement. These entries are NOT present if a Measurement-Status attribute indicates an error.

    ShortCompound numeric measurement entry components
    Comments

    A compound measurement is a measurement that requires more than one value to represent it, such as an acceleration which has an x, y, and z components. The Blood pressure is also represented as a compound measurement, containing systolic, diastolic and MAP components. One combines all the compound elements together to describe the measurement. The Metric-Id-List entry n and Compound-Basic/Simple-Nu-Observed-Value entry n are ordered such that the code that describes each entry n is computed from the partition of the Type attribute and the term code of the Metric-Id-List attribute. In the case of the Compound-Nu-Observed-Value, the term code comes from the Compound-Nu-Observed-Value.metric sub-component.

    Control0..*
    24. Observation.component:compound.code
    BindingThe codes SHALL be taken from 11073 MDC Non-Object codes
    (required to http://hl7.org/fhir/uv/phd/ValueSet/MDCnotObject)
    26. Observation.component:compound.code.coding
    Control1..?
    SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 28. Observation.component:compound.code.coding:MdcType
      Slice NameMdcType
      Definition

      This MDC code expresses what the measurement is

      ShortThe 11073-10101 MDC code for the measurement
      Control1..1
      30. Observation.component:compound.code.coding:MdcType.system
      Control1..?
      Fixed Valueurn:iso:std:iso:11073:10101
      32. Observation.component:compound.code.coding:MdcType.code
      Control1..?
      34. Observation.component:compound.code.coding:LoincCoding
      Slice NameLoincCoding
      Definition

      This (optional) LOINC code expresses what the measurement is

      ShortThe LOINC code for the measurement if a vital sign
      Control0..1
      36. Observation.component:compound.code.coding:LoincCoding.system
      Control1..?
      Fixed Valuehttp://loinc.org
      38. Observation.component:compound.code.coding:LoincCoding.code
      Comments

      Required if the measurement is a vital sign

      Control1..?
      40. Observation.component:compound.code.text
      Definition

      It is recommended to display at least the reference identifier describing the compound sub-element

      42. Observation.component:compound.value[x]
      TypeQuantity
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      44. Observation.component:compound.value[x].value
      Definition

      The value of nth element of the compound attribute. The value element for the nth compoundComponent is missing if the attribute sends a special value or the Compound-Nu-Observed-Value status element indicates an error.

      Control1..?
      46. Observation.component:compound.value[x].system
      Definition

      The unit code shall use the UCUM system

      Control1..?
      Fixed Valuehttp://unitsofmeasure.org
      48. Observation.component:compound.value[x].code
      Definition

      The MDC code must be translated to the UCUM code.

      Control1..?
      50. Observation.component:compound.dataAbsentReason
      Definition

      Provides a reason why the expected value in the nth element Observation.compoundComponent.valueQuantity is missing. This could be a NaN (Not a Number), PINF (Positive infinity), NINF (Negative infinity) or the reserved and not-at-this-resolution special values. It can also be indicated by the (measurement) status field of the Compound-Nu-Observed-Value. Note that the FHIR codes for NAN are no longer 'NAN' but 'not-a-number'. Similar changes have been made for NINF and PINF.

      ShortPopulated when a special value or status in Compound-Nu-Observed-Value indicates invalid, not unavailable, or msmt ongoing
      52. Observation.component:compound.dataAbsentReason.coding
      Control1..?
      SlicingThis element introduces a set of slices on Observation.component.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 54. Observation.component:compound.dataAbsentReason.coding:FhirDefault
        Slice NameFhirDefault
        Control1..1
        56. Observation.component:compound.dataAbsentReason.coding:FhirDefault.system
        Control1..?
        Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
        58. Observation.component:compound.dataAbsentReason.coding:FhirDefault.code
        Control1..?
        60. Observation.component:compound.interpretation
        62. Observation.component:compound.interpretation.coding
        Control1..?
        SlicingThis element introduces a set of slices on Observation.component.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 64. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation
          Slice NameMsmtStatusInterpretation
          ShortMeasurement status interpretation when questionable, calibration-ongoing, validated, early-indication, threshold exceeded, alarm inhibited
          Control1..1
          66. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.system
          Control1..?
          Fixed Valuehttp://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status
          68. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.code
          Control1..?
          70. Observation.component:accuracyComponent
          Slice NameaccuracyComponent
          Definition

          This component shall be present if the Accuracy attribute is present.

          ShortThe accuracy of the measurement
          Control0..1
          72. Observation.component:accuracyComponent.code
          BindingThe codes SHALL be taken from Quantity 11073 Attributes
          (required to http://hl7.org/fhir/uv/phd/ValueSet/Quantity11073MDC)
          74. Observation.component:accuracyComponent.code.coding
          Control1..?
          SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ system
          • 76. Observation.component:accuracyComponent.code.coding:MdcType
            Slice NameMdcType
            ShortThe 11073-10101 MDC code for the measurement
            Control1..1
            78. Observation.component:accuracyComponent.code.coding:MdcType.system
            Control1..?
            Fixed Valueurn:iso:std:iso:11073:10101
            80. Observation.component:accuracyComponent.code.coding:MdcType.code
            Definition

            The code for the Accuracy attribute is 67914

            Control1..?
            Fixed Value67914
            82. Observation.component:accuracyComponent.code.text
            Definition

            Should include the reference identifier for the Accuracy attribute MDC_ATTR_NU_ACCUR_MSMT

            84. Observation.component:accuracyComponent.value[x]
            Control1..?
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 86. Observation.component:accuracyComponent.value[x]:valueQuantity
              Slice NamevalueQuantity
              Control1..1
              TypeQuantity
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              88. Observation.component:accuracyComponent.value[x]:valueQuantity.value
              Definition

              This is the value of the accuracy attribute. The value is Mder FLOAT encoded and shall be expressed to the precision indicated by the Mder FLOAT.

              Control1..?
              90. Observation.component:accuracyComponent.value[x]:valueQuantity.system
              Definition

              The unit code shall use the UCUM system

              Control1..?
              Fixed Valuehttp://unitsofmeasure.org
              92. Observation.component:accuracyComponent.value[x]:valueQuantity.code
              Definition

              The units for the Accuracy are given by the units of the measurement so this entry shall have the same code as in Observation.valueQuantity.code

              Control1..?
              94. Observation.component:accuracyComponent.dataAbsentReason
              Control0..0

              Guidance on how to interpret the contents of this table can be found here

              0. Observation
              Definition

              The PhdCompoundNumericObservation reports PHD measurements that contain one of either a Compound-Basic-Nu-Observed-Value, Compound-Simple-Nu-Observed-Value, or Compound-Nu-Observed-Value attribute.


              Measurements and simple assertions made about a patient, device or other subject.

              ShortMeasurements and simple assertions
              Comments

              Used for compound numeric observations from Personal Health Devices


              Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

              Control0..*
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate NamesVital Signs, Measurement, Results, Tests
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              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 (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
              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 (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
              2. Observation.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control10..1
              TypeMeta
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              4. Observation.meta.security
              Definition

              Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

              ShortSecurity Labels applied to this resource
              Comments

              The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

              Control0..*
              BindingUnless not suitable, these codes SHALL be taken from All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels
              (extensible to http://hl7.org/fhir/ValueSet/security-labels)
              TypeCoding
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Observation.meta.security. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ system
              • value @ code
              • 6. Observation.meta.security:PhdHtest
                Slice NamePhdHtest
                Definition

                Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                ShortSecurity value set to HTEST when measurement status indicates demo or test dataSecurity Labels applied to this resource
                Comments

                The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                Control0..1*
                BindingUnless not suitable, these codes SHALL be taken from All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels
                (extensible to http://hl7.org/fhir/ValueSet/security-labels)
                TypeCoding
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                8. Observation.meta.security:PhdHtest.system
                Definition

                The identification of the code system that defines the meaning of the symbol in the code.

                ShortIdentity of the terminology system
                Comments

                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                Control10..1
                Typeuri
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to be unambiguous about the source of the definition of the symbol.

                Fixed Valuehttp://terminology.hl7.org/CodeSystem/v3-ActReason
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                10. Observation.meta.security:PhdHtest.code
                Definition

                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                ShortSymbol in syntax defined by the system
                Control10..1
                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to refer to a particular code in the system.

                Fixed ValueHTEST
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. Observation.implicitRules
                Definition

                A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                ShortA set of rules under which this content was created
                Comments

                Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                Control0..1
                Typeuri
                Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                14. Observation.extension:GatewayDevice
                Slice NameGatewayDevice
                Definition

                To be used when the actual gateway used at the time of the observation, and the referenced device is also specified. The gateway device may be acting as a communication/data collector, translator or controller; This extension is useful when there is more than one gateway device, for example, where there are apps on a phone and each are a device, and more than one app is used to pass on the data to a FHIR Server. In that case you need to be able to say from the observation which specific app was used to act as gateway. Note that the Provenance/AuditEvent resources can represent the same information.

                ShortGateway Device
                Control0..1
                TypeExtension(Observation Gateway Device) (Extension Type: Reference(Device))
                Is Modifierfalse
                Must Supportfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                16. Observation.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Must Supportfalse
                Summaryfalse
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                18. Observation.identifier
                Definition

                A unique identifier assigned to this observation.

                ShortBusiness Identifier for observation
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                TypeIdentifier
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                Allows observations to be distinguished and referenced.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • exists @ value
                • exists @ system
                • exists @ type
                • 20. Observation.identifier:conditionalCreate
                  Slice NameconditionalCreate
                  Definition

                  An identifier created from a combination of the measurement parameters like sensor time stamp, type code, unit code, patient and device identifiers, and selected elements of any component elements.


                  A unique identifier assigned to this observation.

                  ShortUnique identifier of this measurement for a given patient and deviceBusiness Identifier for observation
                  Comments

                  This value is used in the conditional create to prevent data duplication. PHDs will often re-send already sent data for a variety of reasons. This element is required unless the metric measurement contains no time stamp or is a measurement containing a time stamp that is real time. By real time the time stamp reported by the PHD must be later than the current time reported by the PHD before any measurements are received. There might be other means to ascertain whether the data is real time. Temporarily stored data from IEEE 11073-10206 compliant devices, which are required to be deleted the data after sending, can be considered real time. An example of this are temporarily stored observation from a device implementing the Bluetooth SIG GHS profile or implementing another Bluetooth SIG medical sensor device profile.

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..1*
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  Allows observations to be distinguished in a selective enough manner to prevent resource duplication.


                  Allows observations to be distinguished and referenced.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  22. Observation.identifier:conditionalCreate.use
                  Definition

                  The purpose of this identifier.

                  Shortusual | official | temp | secondary | old (If known)
                  Comments

                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                  Control0..1
                  BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.3.0
                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.3.0)
                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  24. Observation.identifier:conditionalCreate.type
                  Definition

                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                  ShortDescription of identifier
                  Comments

                  This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                  Control0..01
                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows users to make use of identifiers when the identifier system is not known.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  26. Observation.identifier:conditionalCreate.system
                  Definition

                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                  ShortThe namespace for the identifier value
                  Comments

                  Identifier.system is always case sensitive.

                  Control0..01
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                  Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  28. Observation.identifier:conditionalCreate.value
                  Definition

                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                  ShortThe value that is unique
                  Comments

                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Example<br/><b>General</b>:123456
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  30. Observation.status
                  Definition

                  The status of the result value. Either 'final' or 'preliminary'


                  The status of the result value.

                  Shortregistered | preliminary | final | amended +
                  Comments

                  The value shall be set to 'final' unless a Measurement-Status attribute or Nu-Observed-Value attribute status field indicates that the measurement is preliminary. In that case this field shall be set to 'preliminary'


                  This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                  Control1..1
                  BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|4.3.0
                  (required to http://hl7.org/fhir/ValueSet/observation-status|4.3.0)

                  Codes providing the status of an observation.

                  Typecode
                  Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  32. Observation.category
                  Definition

                  A code that classifies the general type of observation being made.

                  ShortClassification of type of observation
                  Comments

                  In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                  Control10..*
                  BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category
                  (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                  Codes for high level observation categories.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Used for filtering what observations are retrieved and displayed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ coding.code
                  • value @ coding.system
                  • 34. Observation.category:PHD-Observation
                    Slice NamePHD-Observation
                    Definition

                    A code that classifies the general type of observation being made.

                    ShortClassification of type of observation
                    Comments

                    The category enables identifying observations generated by PHDs.


                    In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                    Control10..1*
                    BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category
                    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                    Codes for high level observation categories.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    Used for filtering what observations are retrieved and displayed.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    36. Observation.category:PHD-Observation.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control10..*
                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows for alternative encodings within a code system, and translations to other code systems.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    38. Observation.category:PHD-Observation.coding.system
                    Definition

                    The identification of the code system that defines the meaning of the symbol in the code.

                    ShortIdentity of the terminology system
                    Comments

                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                    Control10..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to be unambiguous about the source of the definition of the symbol.

                    Fixed Valuehttp://hl7.org/fhir/uv/phd/CodeSystem/PhdObservationCategories
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    40. Observation.category:PHD-Observation.coding.code
                    Definition

                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                    ShortSymbol in syntax defined by the system
                    Control10..1
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to refer to a particular code in the system.

                    Fixed Valuephd-observation
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    42. Observation.category:VSCat
                    Slice NameVSCat
                    Definition

                    A code that classifies the general type of observation being made.

                    ShortClassification of type of observation
                    Comments

                    In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                    Control0..1*
                    BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category
                    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                    Codes for high level observation categories.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    Used for filtering what observations are retrieved and displayed.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    44. Observation.category:VSCat.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control10..*
                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows for alternative encodings within a code system, and translations to other code systems.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. Observation.category:VSCat.coding.system
                    Definition

                    The identification of the code system that defines the meaning of the symbol in the code.

                    ShortIdentity of the terminology system
                    Comments

                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                    Control10..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to be unambiguous about the source of the definition of the symbol.

                    Fixed Valuehttp://terminology.hl7.org/CodeSystem/observation-category
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    48. Observation.category:VSCat.coding.code
                    Definition

                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                    ShortSymbol in syntax defined by the system
                    Control10..1
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to refer to a particular code in the system.

                    Fixed Valuevital-signs
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    50. Observation.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "name".

                    ShortType of observation (code / type)
                    Comments

                    All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                    Control1..1
                    BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    Alternate NamesName
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    52. Observation.code.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control10..*
                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows for alternative encodings within a code system, and translations to other code systems.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ system
                    • 54. Observation.code.coding:MDCType
                      Slice NameMDCType
                      Definition

                      This MDC code expresses what the measurement is.


                      A reference to a code defined by a terminology system.

                      ShortThe 11073-10101 MDC code for the measurementCode defined by a terminology system
                      Comments

                      The value for the code can be obtained from the IEEE 11073-10206 Observation.type attribute.


                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control10..1*
                      TypeCoding
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      56. Observation.code.coding:MDCType.system
                      Definition

                      The identification of the code system that defines the meaning of the symbol in the code.

                      ShortIdentity of the terminology system
                      Comments

                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                      Control10..1
                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to be unambiguous about the source of the definition of the symbol.

                      Fixed Valueurn:iso:std:iso:11073:10101
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      58. Observation.code.coding:MDCType.code
                      Definition

                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                      ShortSymbol in syntax defined by the system
                      Comments

                      Required for all measurements

                      Control10..1
                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to refer to a particular code in the system.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      60. Observation.code.coding:LoincCoding
                      Slice NameLoincCoding
                      Definition

                      This LOINC code expresses what the measurement is


                      A reference to a code defined by a terminology system.

                      ShortThe LOINC code for the measurementCode defined by a terminology system
                      Comments

                      If the observation is one of the FHIR-defined vital signs observation, the equivalent LOINC code for that vital sign as specified by FHIR appears here.


                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control0..1*
                      TypeCoding
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      62. Observation.code.coding:LoincCoding.system
                      Definition

                      The identification of the code system that defines the meaning of the symbol in the code.

                      ShortIdentity of the terminology system
                      Comments

                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                      Control10..1
                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to be unambiguous about the source of the definition of the symbol.

                      Fixed Valuehttp://loinc.org
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      64. Observation.code.coding:LoincCoding.code
                      Definition

                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                      ShortSymbol in syntax defined by the system
                      Comments

                      Required if the measurement is a vital sign

                      Control10..1
                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to refer to a particular code in the system.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      66. Observation.subject
                      Definition

                      The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

                      ShortWho and/or what the observation is about
                      Comments

                      One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                      Control10..1
                      TypeReference(Patient, Group, Device, Location, Organization, Procedure, Practitioner, Medication, Substance)
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      Observations have no value if you don't know who or what they're about.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      68. Observation.subject.reference
                      Definition

                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                      ShortLiteral reference, Relative, internal or absolute URL
                      Comments

                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                      Control10..1
                      This element is affected by the following invariants: ref-1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      70. Observation.effective[x]
                      Definition

                      The time or time-period the observed value is asserted as being true. It is a time period if a Measure-Active-Period (duration) attribute is part of the metric measurement sent by the PHD. Otherwise it is the time stamp sent by the PHD or the time of reception by the PHG if the PHD sent no time stamp.


                      The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

                      ShortClinically relevant time/time-period for observation
                      Comments

                      At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                      Control10..1
                      TypeChoice of: dateTime, Period, Timing, instant
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                      Alternate NamesOccurrence
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      72. Observation.value[x]
                      Definition

                      The information determined as a result of making the observation, if the information has a simple value.

                      ShortActual result
                      Comments

                      An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                      Control0..01
                      This element is affected by the following invariants: obs-7
                      TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      74. Observation.dataAbsentReason
                      Definition

                      Provides a reason why no measurement compoundComponent elements are present. This situation only happens if the Measurement-Status attribute indicates a generic error.


                      Provides a reason why the expected value in the element Observation.value[x] is missing.

                      ShortWhy the result is missing
                      Comments

                      Special values reported in the Compound-Basic/Simple-Nu-Observed-Value are handled individually in each compoundComponent element and are not considered generic. The Compound-Nu-Observed-Value has its own status entry and it is also handled in the component elements representing the compound.


                      Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                      The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                      Control0..1
                      This element is affected by the following invariants: obs-6
                      BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                      (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                      Codes specifying why the result (Observation.value[x]) is missing.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Requirements

                      For many results it is necessary to handle exceptional values in measurements.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. Observation.dataAbsentReason.coding
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control10..*
                      TypeCoding
                      Is Modifierfalse
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Observation.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ system
                      • 78. Observation.dataAbsentReason.coding:FhirDefault
                        Slice NameFhirDefault
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control10..1*
                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        80. Observation.dataAbsentReason.coding:FhirDefault.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        82. Observation.dataAbsentReason.coding:FhirDefault.code
                        Definition

                        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        84. Observation.device
                        Definition

                        The device used to generate the observation data.

                        Short(Measurement) Device
                        Comments

                        This field will reference the PHD Device.


                        Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                        Control10..1
                        TypeReference(Device, DeviceMetric)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        86. Observation.device.reference
                        Definition

                        Reference to the device-related resources that describe the sensor device taking the measurement. This element will point to a Device resource following the Phd Device Profile.


                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                        ShortReference to the device responsible for the measurementLiteral reference, Relative, internal or absolute URL
                        Comments

                        This reference points to the Device resource containing information about the sensor device that took the measurement.


                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                        Control10..1
                        This element is affected by the following invariants: ref-1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        88. Observation.component
                        Definition

                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                        ShortComponent results
                        Comments

                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Requirements

                        Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                        SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ code
                        • 90. Observation.component.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          92. Observation.component.code
                          Definition

                          Describes what was observed. Sometimes this is called the observation "code".

                          ShortType of component observation (code / type)
                          Comments

                          All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                          Control1..1
                          BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes
                          (example to http://hl7.org/fhir/ValueSet/observation-codes)

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supportfalse
                          Summarytrue
                          Requirements

                          Knowing what kind of observation is being made is essential to understanding the observation.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          94. Observation.component:supplementalTypesComponent
                          Slice NamesupplementalTypesComponent
                          Definition

                          For each partition:term code pair contained in the Supplemental-Types attribute, a separate supplementalTypesComponent element is generated. The component is not generated if the attribute is absent or empty. The component shall be generated otherwise.


                          Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                          ShortSupplemental Type: A further description of the measurement type.Component results
                          Comments

                          A PHD may send a Supplemental-Types attribute as part of the measurement. This attribute consists of a set of MDC nomenclature codes as partition:term code pairs. Each pair is a code describing something additional about the measurement, such as MDC_MODALITY_SPOT in the pulse oximeter which indicates that the provided measurement is a stable average. An MDC_MODALITY_FAST would indicate that a short averaging is used and the result reported regardless of stability.


                          For a discussion on the ways Observations can be assembled in groups together see Notes below.

                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supportfalse
                          Summarytrue
                          Requirements

                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                          96. Observation.component:supplementalTypesComponent.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          98. Observation.component:supplementalTypesComponent.code
                          Definition

                          Describes what was observed. Sometimes this is called the observation "code".

                          ShortType of component observation (code / type)
                          Comments

                          All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                          Control1..1
                          BindingThe codes SHALL be taken from For example codes, see CodeableConcept 11073 Attributeshttp://hl7.org/fhir/ValueSet/observation-codes
                          (required to http://hl7.org/fhir/uv/phd/ValueSet/CodeableConcept11073MDC)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supportfalse
                          Summarytrue
                          Requirements

                          Knowing what kind of observation is being made is essential to understanding the observation.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          100. Observation.component:supplementalTypesComponent.code.coding
                          Definition

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control10..*
                          TypeCoding
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Allows for alternative encodings within a code system, and translations to other code systems.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ system
                          • 102. Observation.component:supplementalTypesComponent.code.coding:MdcType
                            Slice NameMdcType
                            Definition

                            A reference to a code defined by a terminology system.

                            ShortThe 11073-10101 MDC code for the measurementCode defined by a terminology system
                            Comments

                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                            Control10..1*
                            TypeCoding
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Allows for alternative encodings within a code system, and translations to other code systems.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            104. Observation.component:supplementalTypesComponent.code.coding:MdcType.system
                            Definition

                            The identification of the code system that defines the meaning of the symbol in the code.

                            ShortIdentity of the terminology system
                            Comments

                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                            Control10..1
                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be unambiguous about the source of the definition of the symbol.

                            Fixed Valueurn:iso:std:iso:11073:10101
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            106. Observation.component:supplementalTypesComponent.code.coding:MdcType.code
                            Definition

                            68193 is the 32-bit nomenclature code indicating a 'Supplemental-Types' value


                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                            ShortSymbol in syntax defined by the system
                            Control10..1
                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to refer to a particular code in the system.

                            Fixed Value68193
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            108. Observation.component:supplementalTypesComponent.value[x]
                            Definition

                            The information determined as a result of making the observation, if the information has a simple value.

                            ShortActual component result
                            Comments

                            Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                            Control10..1
                            TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 110. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept
                              Slice NamevalueCodeableConcept
                              Definition

                              The supplemental information determined as a result of making the observation, if the information is a code.


                              The information determined as a result of making the observation, if the information has a simple value.

                              ShortActual component result
                              Comments

                              Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                              Control10..1
                              TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Must Supportfalse
                              Summarytrue
                              Requirements

                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              112. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding
                              Definition

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                              Control10..*
                              TypeCoding
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows for alternative encodings within a code system, and translations to other code systems.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Observation.component.value[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ system
                              • 114. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType
                                Slice NameMDCType
                                Definition

                                A reference to a code defined by a terminology system.

                                ShortRequired MDC code entry.Code defined by a terminology system
                                Comments

                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                Control10..1*
                                TypeCoding
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                Allows for alternative encodings within a code system, and translations to other code systems.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                116. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.system
                                Definition

                                The identification of the code system that defines the meaning of the symbol in the code.

                                ShortIdentity of the terminology system
                                Comments

                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                Control10..1
                                Typeuri
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Need to be unambiguous about the source of the definition of the symbol.

                                Fixed Valueurn:iso:std:iso:11073:10101
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                118. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.code
                                Definition

                                For the given Supplemental-Types entry the code here is given by: partition * 2**16 + term code


                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                ShortSymbol in syntax defined by the system
                                Control10..1
                                Typecode
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Need to refer to a particular code in the system.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                120. Observation.component:supplementalTypesComponent.dataAbsentReason
                                Definition

                                Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                ShortWhy the component result is missing
                                Comments

                                "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                Control0..01
                                This element is affected by the following invariants: obs-6
                                BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                                (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                Codes specifying why the result (Observation.value[x]) is missing.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supportfalse
                                Summaryfalse
                                Requirements

                                For many results it is necessary to handle exceptional values in measurements.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                122. Observation.component:compound
                                Slice Namecompound
                                Definition

                                Each compoundComponent contains one of the N constituents of the compound measurement. These entries are NOT present if a Measurement-Status attribute indicates an error.


                                Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                ShortCompound numeric measurement entry componentsComponent results
                                Comments

                                A compound measurement is a measurement that requires more than one value to represent it, such as an acceleration which has an x, y, and z components. The Blood pressure is also represented as a compound measurement, containing systolic, diastolic and MAP components. One combines all the compound elements together to describe the measurement. The Metric-Id-List entry n and Compound-Basic/Simple-Nu-Observed-Value entry n are ordered such that the code that describes each entry n is computed from the partition of the Type attribute and the term code of the Metric-Id-List attribute. In the case of the Compound-Nu-Observed-Value, the term code comes from the Compound-Nu-Observed-Value.metric sub-component.


                                For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                Control0..*
                                TypeBackboneElement
                                Is Modifierfalse
                                Must Supportfalse
                                Summarytrue
                                Requirements

                                Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                124. Observation.component:compound.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                126. Observation.component:compound.code
                                Definition

                                Describes what was observed. Sometimes this is called the observation "code".

                                ShortType of component observation (code / type)
                                Comments

                                All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                Control1..1
                                BindingThe codes SHALL be taken from For example codes, see 11073 MDC Non-Object codeshttp://hl7.org/fhir/ValueSet/observation-codes
                                (required to http://hl7.org/fhir/uv/phd/ValueSet/MDCnotObject)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supportfalse
                                Summarytrue
                                Requirements

                                Knowing what kind of observation is being made is essential to understanding the observation.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                128. Observation.component:compound.code.coding
                                Definition

                                A reference to a code defined by a terminology system.

                                ShortCode defined by a terminology system
                                Comments

                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                Control10..*
                                TypeCoding
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                Allows for alternative encodings within a code system, and translations to other code systems.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ system
                                • 130. Observation.component:compound.code.coding:MdcType
                                  Slice NameMdcType
                                  Definition

                                  This MDC code expresses what the measurement is


                                  A reference to a code defined by a terminology system.

                                  ShortThe 11073-10101 MDC code for the measurementCode defined by a terminology system
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control10..1*
                                  TypeCoding
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  132. Observation.component:compound.code.coding:MdcType.system
                                  Definition

                                  The identification of the code system that defines the meaning of the symbol in the code.

                                  ShortIdentity of the terminology system
                                  Comments

                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                  Control10..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to be unambiguous about the source of the definition of the symbol.

                                  Fixed Valueurn:iso:std:iso:11073:10101
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  134. Observation.component:compound.code.coding:MdcType.code
                                  Definition

                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                  ShortSymbol in syntax defined by the system
                                  Control10..1
                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to refer to a particular code in the system.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  136. Observation.component:compound.code.coding:LoincCoding
                                  Slice NameLoincCoding
                                  Definition

                                  This (optional) LOINC code expresses what the measurement is


                                  A reference to a code defined by a terminology system.

                                  ShortThe LOINC code for the measurement if a vital signCode defined by a terminology system
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control0..1*
                                  TypeCoding
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  138. Observation.component:compound.code.coding:LoincCoding.system
                                  Definition

                                  The identification of the code system that defines the meaning of the symbol in the code.

                                  ShortIdentity of the terminology system
                                  Comments

                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                  Control10..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to be unambiguous about the source of the definition of the symbol.

                                  Fixed Valuehttp://loinc.org
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  140. Observation.component:compound.code.coding:LoincCoding.code
                                  Definition

                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                  ShortSymbol in syntax defined by the system
                                  Comments

                                  Required if the measurement is a vital sign

                                  Control10..1
                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to refer to a particular code in the system.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  142. Observation.component:compound.code.text
                                  Definition

                                  It is recommended to display at least the reference identifier describing the compound sub-element


                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                  ShortPlain text representation of the concept
                                  Comments

                                  Very often the text is the same as a displayName of one of the codings.

                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  144. Observation.component:compound.value[x]
                                  Definition

                                  The information determined as a result of making the observation, if the information has a simple value.

                                  ShortActual component result
                                  Comments

                                  Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                  Control0..1
                                  TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summarytrue
                                  Requirements

                                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  146. Observation.component:compound.value[x].value
                                  Definition

                                  The value of nth element of the compound attribute. The value element for the nth compoundComponent is missing if the attribute sends a special value or the Compound-Nu-Observed-Value status element indicates an error.


                                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                  ShortNumerical value (with implicit precision)
                                  Comments

                                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                  Control10..1
                                  Typedecimal
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Precision is handled implicitly in almost all cases of measurement.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  148. Observation.component:compound.value[x].comparator
                                  Definition

                                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                  Short< | <= | >= | > - how to understand the value
                                  Control0..1
                                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0
                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0)
                                  Typecode
                                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  150. Observation.component:compound.value[x].system
                                  Definition

                                  The unit code shall use the UCUM system


                                  The identification of the system that provides the coded form of the unit.

                                  ShortSystem that defines coded unit form
                                  Control10..1
                                  This element is affected by the following invariants: qty-3
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to know the system that defines the coded form of the unit.

                                  Fixed Valuehttp://unitsofmeasure.org
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  152. Observation.component:compound.value[x].code
                                  Definition

                                  The MDC code must be translated to the UCUM code.


                                  A computer processable form of the unit in some unit representation system.

                                  ShortCoded form of the unit
                                  Comments

                                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                  Control10..1
                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  154. Observation.component:compound.dataAbsentReason
                                  Definition

                                  Provides a reason why the expected value in the nth element Observation.compoundComponent.valueQuantity is missing. This could be a NaN (Not a Number), PINF (Positive infinity), NINF (Negative infinity) or the reserved and not-at-this-resolution special values. It can also be indicated by the (measurement) status field of the Compound-Nu-Observed-Value. Note that the FHIR codes for NAN are no longer 'NAN' but 'not-a-number'. Similar changes have been made for NINF and PINF.


                                  Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                  ShortPopulated when a special value or status in Compound-Nu-Observed-Value indicates invalid, not unavailable, or msmt ongoingWhy the component result is missing
                                  Comments

                                  "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                  The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                  Control0..1
                                  This element is affected by the following invariants: obs-6
                                  BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                                  (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                  Codes specifying why the result (Observation.value[x]) is missing.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Requirements

                                  For many results it is necessary to handle exceptional values in measurements.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  156. Observation.component:compound.dataAbsentReason.coding
                                  Definition

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control10..*
                                  TypeCoding
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on Observation.component.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ system
                                  • 158. Observation.component:compound.dataAbsentReason.coding:FhirDefault
                                    Slice NameFhirDefault
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                    Control10..1*
                                    TypeCoding
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    160. Observation.component:compound.dataAbsentReason.coding:FhirDefault.system
                                    Definition

                                    The identification of the code system that defines the meaning of the symbol in the code.

                                    ShortIdentity of the terminology system
                                    Comments

                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                    Control10..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to be unambiguous about the source of the definition of the symbol.

                                    Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    162. Observation.component:compound.dataAbsentReason.coding:FhirDefault.code
                                    Definition

                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                    ShortSymbol in syntax defined by the system
                                    Control10..1
                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to refer to a particular code in the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    164. Observation.component:accuracyComponent
                                    Slice NameaccuracyComponent
                                    Definition

                                    This component shall be present if the Accuracy attribute is present.


                                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                    ShortThe accuracy of the measurementComponent results
                                    Comments

                                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                    Control0..1*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Requirements

                                    Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                    166. Observation.component:accuracyComponent.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    168. Observation.component:accuracyComponent.code
                                    Definition

                                    Describes what was observed. Sometimes this is called the observation "code".

                                    ShortType of component observation (code / type)
                                    Comments

                                    All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                    Control1..1
                                    BindingThe codes SHALL be taken from For example codes, see Quantity 11073 Attributeshttp://hl7.org/fhir/ValueSet/observation-codes
                                    (required to http://hl7.org/fhir/uv/phd/ValueSet/Quantity11073MDC)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supportfalse
                                    Summarytrue
                                    Requirements

                                    Knowing what kind of observation is being made is essential to understanding the observation.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    170. Observation.component:accuracyComponent.code.coding
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                    Control10..*
                                    TypeCoding
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ system
                                    • 172. Observation.component:accuracyComponent.code.coding:MdcType
                                      Slice NameMdcType
                                      Definition

                                      A reference to a code defined by a terminology system.

                                      ShortThe 11073-10101 MDC code for the measurementCode defined by a terminology system
                                      Comments

                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                      Control10..1*
                                      TypeCoding
                                      Is Modifierfalse
                                      Summarytrue
                                      Requirements

                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      174. Observation.component:accuracyComponent.code.coding:MdcType.system
                                      Definition

                                      The identification of the code system that defines the meaning of the symbol in the code.

                                      ShortIdentity of the terminology system
                                      Comments

                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                      Control10..1
                                      Typeuri
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be unambiguous about the source of the definition of the symbol.

                                      Fixed Valueurn:iso:std:iso:11073:10101
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      176. Observation.component:accuracyComponent.code.coding:MdcType.code
                                      Definition

                                      The code for the Accuracy attribute is 67914


                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                      ShortSymbol in syntax defined by the system
                                      Control10..1
                                      Typecode
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to refer to a particular code in the system.

                                      Fixed Value67914
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      178. Observation.component:accuracyComponent.code.text
                                      Definition

                                      Should include the reference identifier for the Accuracy attribute MDC_ATTR_NU_ACCUR_MSMT


                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                      ShortPlain text representation of the concept
                                      Comments

                                      Very often the text is the same as a displayName of one of the codings.

                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      180. Observation.component:accuracyComponent.value[x]
                                      Definition

                                      The information determined as a result of making the observation, if the information has a simple value.

                                      ShortActual component result
                                      Comments

                                      Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                      Control10..1
                                      TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      Requirements

                                      An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                      • type @ $this
                                      • 182. Observation.component:accuracyComponent.value[x]:valueQuantity
                                        Slice NamevalueQuantity
                                        Definition

                                        The information determined as a result of making the observation, if the information has a simple value.

                                        ShortActual component result
                                        Comments

                                        Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                        Control10..1
                                        TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        Requirements

                                        An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        184. Observation.component:accuracyComponent.value[x]:valueQuantity.value
                                        Definition

                                        This is the value of the accuracy attribute. The value is Mder FLOAT encoded and shall be expressed to the precision indicated by the Mder FLOAT.


                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                        ShortNumerical value (with implicit precision)
                                        Comments

                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                        Control10..1
                                        Typedecimal
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Precision is handled implicitly in almost all cases of measurement.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        186. Observation.component:accuracyComponent.value[x]:valueQuantity.comparator
                                        Definition

                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                        Short< | <= | >= | > - how to understand the value
                                        Control0..1
                                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0
                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0)
                                        Typecode
                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        188. Observation.component:accuracyComponent.value[x]:valueQuantity.system
                                        Definition

                                        The unit code shall use the UCUM system


                                        The identification of the system that provides the coded form of the unit.

                                        ShortSystem that defines coded unit form
                                        Control10..1
                                        This element is affected by the following invariants: qty-3
                                        Typeuri
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need to know the system that defines the coded form of the unit.

                                        Fixed Valuehttp://unitsofmeasure.org
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        190. Observation.component:accuracyComponent.value[x]:valueQuantity.code
                                        Definition

                                        The units for the Accuracy are given by the units of the measurement so this entry shall have the same code as in Observation.valueQuantity.code


                                        A computer processable form of the unit in some unit representation system.

                                        ShortCoded form of the unit
                                        Comments

                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                        Control10..1
                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        192. Observation.component:accuracyComponent.dataAbsentReason
                                        Definition

                                        Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                        ShortWhy the component result is missing
                                        Comments

                                        "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                        The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                        Control0..01
                                        This element is affected by the following invariants: obs-6
                                        BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                                        (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                        Codes specifying why the result (Observation.value[x]) is missing.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Requirements

                                        For many results it is necessary to handle exceptional values in measurements.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                                        Guidance on how to interpret the contents of this table can be found here

                                        0. Observation
                                        Definition

                                        The PhdCompoundNumericObservation reports PHD measurements that contain one of either a Compound-Basic-Nu-Observed-Value, Compound-Simple-Nu-Observed-Value, or Compound-Nu-Observed-Value attribute.

                                        ShortMeasurements and simple assertions
                                        Comments

                                        Used for compound numeric observations from Personal Health Devices

                                        Control0..*
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Alternate NamesVital Signs, Measurement, Results, Tests
                                        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                        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 (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
                                        dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                        dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                        obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                        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 (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
                                        2. Observation.id
                                        Definition

                                        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                                        ShortLogical id of this artifact
                                        Comments

                                        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                                        Control0..1
                                        Typeid
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        4. Observation.meta
                                        Definition

                                        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                                        ShortMetadata about the resource
                                        Control1..1
                                        TypeMeta
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        6. Observation.meta.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typeid
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        8. Observation.meta.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on Observation.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 10. Observation.meta.versionId
                                          Definition

                                          The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                                          ShortVersion specific identifier
                                          Comments

                                          The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                                          Control0..1
                                          Typeid
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          12. Observation.meta.lastUpdated
                                          Definition

                                          When the resource last changed - e.g. when the version changed.

                                          ShortWhen the resource version last changed
                                          Comments

                                          This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                                          Control0..1
                                          Typeinstant
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          14. Observation.meta.source
                                          Definition

                                          A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                                          ShortIdentifies where the resource comes from
                                          Comments

                                          In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                                          This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                                          Control0..1
                                          Typeuri
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          16. Observation.meta.profile
                                          Definition

                                          A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                                          ShortProfiles this resource claims to conform to
                                          Comments

                                          It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                                          Control0..*
                                          Typecanonical(StructureDefinition)
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          18. Observation.meta.security
                                          Definition

                                          Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                                          ShortSecurity Labels applied to this resource
                                          Comments

                                          The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                                          Control0..*
                                          BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                          (extensible to http://hl7.org/fhir/ValueSet/security-labels)
                                          TypeCoding
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          SlicingThis element introduces a set of slices on Observation.meta.security. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ system
                                          • value @ code
                                          • 20. Observation.meta.security:PhdHtest
                                            Slice NamePhdHtest
                                            Definition

                                            Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                                            ShortSecurity value set to HTEST when measurement status indicates demo or test data
                                            Comments

                                            The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                            (extensible to http://hl7.org/fhir/ValueSet/security-labels)
                                            TypeCoding
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            22. Observation.meta.security:PhdHtest.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typeid
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            24. Observation.meta.security:PhdHtest.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            SlicingThis element introduces a set of slices on Observation.meta.security.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 26. Observation.meta.security:PhdHtest.system
                                              Definition

                                              The identification of the code system that defines the meaning of the symbol in the code.

                                              ShortIdentity of the terminology system
                                              Comments

                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                              Control1..1
                                              Typeuri
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to be unambiguous about the source of the definition of the symbol.

                                              Fixed Valuehttp://terminology.hl7.org/CodeSystem/v3-ActReason
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              28. Observation.meta.security:PhdHtest.version
                                              Definition

                                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                              ShortVersion of the system - if relevant
                                              Comments

                                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              30. Observation.meta.security:PhdHtest.code
                                              Definition

                                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                              ShortSymbol in syntax defined by the system
                                              Control1..1
                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to refer to a particular code in the system.

                                              Fixed ValueHTEST
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              32. Observation.meta.security:PhdHtest.display
                                              Definition

                                              A representation of the meaning of the code in the system, following the rules of the system.

                                              ShortRepresentation defined by the system
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              34. Observation.meta.security:PhdHtest.userSelected
                                              Definition

                                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                              ShortIf this coding was chosen directly by the user
                                              Comments

                                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                              Control0..1
                                              Typeboolean
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              36. Observation.meta.tag
                                              Definition

                                              Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                                              ShortTags applied to this resource
                                              Comments

                                              The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                                              Control0..*
                                              BindingFor example codes, see CommonTags
                                              (example to http://hl7.org/fhir/ValueSet/common-tags)
                                              TypeCoding
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              38. Observation.implicitRules
                                              Definition

                                              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                              ShortA set of rules under which this content was created
                                              Comments

                                              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                              Control0..1
                                              Typeuri
                                              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              40. Observation.language
                                              Definition

                                              The base language in which the resource is written.

                                              ShortLanguage of the resource content
                                              Comments

                                              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                                              Control0..1
                                              BindingThe codes SHOULD be taken from CommonLanguages
                                              (preferred to http://hl7.org/fhir/ValueSet/languages)

                                              IETF language tag

                                              Additional BindingsPurpose
                                              AllLanguagesMax Binding
                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              42. Observation.text
                                              Definition

                                              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                                              ShortText summary of the resource, for human interpretation
                                              Comments

                                              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                                              Control0..1
                                              TypeNarrative
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Alternate Namesnarrative, html, xhtml, display
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              44. Observation.contained
                                              Definition

                                              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                                              ShortContained, inline Resources
                                              Comments

                                              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                                              Control0..*
                                              TypeResource
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Alternate Namesinline resources, anonymous resources, contained resources
                                              Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
                                              46. Observation.extension
                                              Definition

                                              An Extension

                                              ShortExtension
                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              SlicingThis element introduces a set of slices on Observation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 48. Observation.extension:GatewayDevice
                                                Slice NameGatewayDevice
                                                Definition

                                                To be used when the actual gateway used at the time of the observation, and the referenced device is also specified. The gateway device may be acting as a communication/data collector, translator or controller; This extension is useful when there is more than one gateway device, for example, where there are apps on a phone and each are a device, and more than one app is used to pass on the data to a FHIR Server. In that case you need to be able to say from the observation which specific app was used to act as gateway. Note that the Provenance/AuditEvent resources can represent the same information.

                                                ShortGateway Device
                                                Control0..1
                                                TypeExtension(Observation Gateway Device) (Extension Type: Reference(Device))
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                50. Observation.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                                Must Supportfalse
                                                Summaryfalse
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                52. Observation.identifier
                                                Definition

                                                A unique identifier assigned to this observation.

                                                ShortBusiness Identifier for observation
                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                Control0..*
                                                TypeIdentifier
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Summarytrue
                                                Requirements

                                                Allows observations to be distinguished and referenced.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • exists @ value
                                                • exists @ system
                                                • exists @ type
                                                • 54. Observation.identifier:conditionalCreate
                                                  Slice NameconditionalCreate
                                                  Definition

                                                  An identifier created from a combination of the measurement parameters like sensor time stamp, type code, unit code, patient and device identifiers, and selected elements of any component elements.

                                                  ShortUnique identifier of this measurement for a given patient and device
                                                  Comments

                                                  This value is used in the conditional create to prevent data duplication. PHDs will often re-send already sent data for a variety of reasons. This element is required unless the metric measurement contains no time stamp or is a measurement containing a time stamp that is real time. By real time the time stamp reported by the PHD must be later than the current time reported by the PHD before any measurements are received. There might be other means to ascertain whether the data is real time. Temporarily stored data from IEEE 11073-10206 compliant devices, which are required to be deleted the data after sending, can be considered real time. An example of this are temporarily stored observation from a device implementing the Bluetooth SIG GHS profile or implementing another Bluetooth SIG medical sensor device profile.

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..1
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Requirements

                                                  Allows observations to be distinguished in a selective enough manner to prevent resource duplication.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  56. Observation.identifier:conditionalCreate.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typeid
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  58. Observation.identifier:conditionalCreate.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Observation.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 60. Observation.identifier:conditionalCreate.use
                                                    Definition

                                                    The purpose of this identifier.

                                                    Shortusual | official | temp | secondary | old (If known)
                                                    Comments

                                                    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                    Control0..1
                                                    BindingThe codes SHALL be taken from IdentifierUse
                                                    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.3.0)
                                                    Typecode
                                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    62. Observation.identifier:conditionalCreate.type
                                                    Definition

                                                    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                    ShortDescription of identifier
                                                    Comments

                                                    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                    Control0..0
                                                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)
                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    Allows users to make use of identifiers when the identifier system is not known.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    64. Observation.identifier:conditionalCreate.system
                                                    Definition

                                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                    ShortThe namespace for the identifier value
                                                    Comments

                                                    Identifier.system is always case sensitive.

                                                    Control0..0
                                                    Typeuri
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    66. Observation.identifier:conditionalCreate.value
                                                    Definition

                                                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                    ShortThe value that is unique
                                                    Comments

                                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                    Control1..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Example<br/><b>General</b>:123456
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    68. Observation.identifier:conditionalCreate.period
                                                    Definition

                                                    Time period during which identifier is/was valid for use.

                                                    ShortTime period when id is/was valid for use
                                                    Control0..1
                                                    TypePeriod
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    70. Observation.identifier:conditionalCreate.assigner
                                                    Definition

                                                    Organization that issued/manages the identifier.

                                                    ShortOrganization that issued id (may be just text)
                                                    Comments

                                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                    Control0..1
                                                    TypeReference(Organization)
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    72. Observation.basedOn
                                                    Definition

                                                    A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

                                                    ShortFulfills plan, proposal or order
                                                    Control0..*
                                                    TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Requirements

                                                    Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                                                    Alternate NamesFulfills
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    74. Observation.partOf
                                                    Definition

                                                    A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

                                                    ShortPart of referenced event
                                                    Comments

                                                    To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

                                                    Control0..*
                                                    TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Immunization, ImagingStudy)
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Alternate NamesContainer
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    76. Observation.status
                                                    Definition

                                                    The status of the result value. Either 'final' or 'preliminary'

                                                    Shortregistered | preliminary | final | amended +
                                                    Comments

                                                    The value shall be set to 'final' unless a Measurement-Status attribute or Nu-Observed-Value attribute status field indicates that the measurement is preliminary. In that case this field shall be set to 'preliminary'

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from ObservationStatus
                                                    (required to http://hl7.org/fhir/ValueSet/observation-status|4.3.0)

                                                    Codes providing the status of an observation.

                                                    Typecode
                                                    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supportfalse
                                                    Summarytrue
                                                    Requirements

                                                    Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    78. Observation.category
                                                    Definition

                                                    A code that classifies the general type of observation being made.

                                                    ShortClassification of type of observation
                                                    Comments

                                                    In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                    Control1..*
                                                    BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                                                    Codes for high level observation categories.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Used for filtering what observations are retrieved and displayed.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ coding.code
                                                    • value @ coding.system
                                                    • 80. Observation.category:PHD-Observation
                                                      Slice NamePHD-Observation
                                                      Definition

                                                      A code that classifies the general type of observation being made.

                                                      ShortClassification of type of observation
                                                      Comments

                                                      The category enables identifying observations generated by PHDs.

                                                      Control1..1
                                                      BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                      (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                                                      Codes for high level observation categories.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Used for filtering what observations are retrieved and displayed.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      82. Observation.category:PHD-Observation.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typeid
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      84. Observation.category:PHD-Observation.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 86. Observation.category:PHD-Observation.coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                        Control1..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        88. Observation.category:PHD-Observation.coding.id
                                                        Definition

                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typeid
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        90. Observation.category:PHD-Observation.coding.extension
                                                        Definition

                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                        ShortAdditional content defined by implementations
                                                        Comments

                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Alternate Namesextensions, user content
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                        SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 92. Observation.category:PHD-Observation.coding.system
                                                          Definition

                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                          ShortIdentity of the terminology system
                                                          Comments

                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                          Control1..1
                                                          Typeuri
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                          Fixed Valuehttp://hl7.org/fhir/uv/phd/CodeSystem/PhdObservationCategories
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          94. Observation.category:PHD-Observation.coding.version
                                                          Definition

                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                          ShortVersion of the system - if relevant
                                                          Comments

                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          96. Observation.category:PHD-Observation.coding.code
                                                          Definition

                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                          ShortSymbol in syntax defined by the system
                                                          Control1..1
                                                          Typecode
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to refer to a particular code in the system.

                                                          Fixed Valuephd-observation
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          98. Observation.category:PHD-Observation.coding.display
                                                          Definition

                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                          ShortRepresentation defined by the system
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          100. Observation.category:PHD-Observation.coding.userSelected
                                                          Definition

                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                          ShortIf this coding was chosen directly by the user
                                                          Comments

                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                          Control0..1
                                                          Typeboolean
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          102. Observation.category:PHD-Observation.text
                                                          Definition

                                                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                          ShortPlain text representation of the concept
                                                          Comments

                                                          Very often the text is the same as a displayName of one of the codings.

                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          104. Observation.category:VSCat
                                                          Slice NameVSCat
                                                          Definition

                                                          A code that classifies the general type of observation being made.

                                                          ShortClassification of type of observation
                                                          Comments

                                                          In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                          Control0..1
                                                          BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                          (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                                                          Codes for high level observation categories.

                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Used for filtering what observations are retrieved and displayed.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          106. Observation.category:VSCat.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typeid
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          108. Observation.category:VSCat.extension
                                                          Definition

                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 110. Observation.category:VSCat.coding
                                                            Definition

                                                            A reference to a code defined by a terminology system.

                                                            ShortCode defined by a terminology system
                                                            Comments

                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                            Control1..*
                                                            TypeCoding
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            112. Observation.category:VSCat.coding.id
                                                            Definition

                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typeid
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            114. Observation.category:VSCat.coding.extension
                                                            Definition

                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                            ShortAdditional content defined by implementations
                                                            Comments

                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 116. Observation.category:VSCat.coding.system
                                                              Definition

                                                              The identification of the code system that defines the meaning of the symbol in the code.

                                                              ShortIdentity of the terminology system
                                                              Comments

                                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                              Control1..1
                                                              Typeuri
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              Need to be unambiguous about the source of the definition of the symbol.

                                                              Fixed Valuehttp://terminology.hl7.org/CodeSystem/observation-category
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              118. Observation.category:VSCat.coding.version
                                                              Definition

                                                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                              ShortVersion of the system - if relevant
                                                              Comments

                                                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              120. Observation.category:VSCat.coding.code
                                                              Definition

                                                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                              ShortSymbol in syntax defined by the system
                                                              Control1..1
                                                              Typecode
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              Need to refer to a particular code in the system.

                                                              Fixed Valuevital-signs
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              122. Observation.category:VSCat.coding.display
                                                              Definition

                                                              A representation of the meaning of the code in the system, following the rules of the system.

                                                              ShortRepresentation defined by the system
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              124. Observation.category:VSCat.coding.userSelected
                                                              Definition

                                                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                              ShortIf this coding was chosen directly by the user
                                                              Comments

                                                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                              Control0..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              126. Observation.category:VSCat.text
                                                              Definition

                                                              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                              ShortPlain text representation of the concept
                                                              Comments

                                                              Very often the text is the same as a displayName of one of the codings.

                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              128. Observation.code
                                                              Definition

                                                              Describes what was observed. Sometimes this is called the observation "name".

                                                              ShortType of observation (code / type)
                                                              Comments

                                                              All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                              Control1..1
                                                              BindingFor example codes, see LOINCCodes
                                                              (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                              Codes identifying names of simple observations.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summarytrue
                                                              Requirements

                                                              Knowing what kind of observation is being made is essential to understanding the observation.

                                                              Alternate NamesName
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              130. Observation.code.id
                                                              Definition

                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typeid
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              132. Observation.code.extension
                                                              Definition

                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                              ShortAdditional content defined by implementations
                                                              Comments

                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              SlicingThis element introduces a set of slices on Observation.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 134. Observation.code.coding
                                                                Definition

                                                                A reference to a code defined by a terminology system.

                                                                ShortCode defined by a terminology system
                                                                Comments

                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                Control1..*
                                                                TypeCoding
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Requirements

                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ system
                                                                • 136. Observation.code.coding:MDCType
                                                                  Slice NameMDCType
                                                                  Definition

                                                                  This MDC code expresses what the measurement is.

                                                                  ShortThe 11073-10101 MDC code for the measurement
                                                                  Comments

                                                                  The value for the code can be obtained from the IEEE 11073-10206 Observation.type attribute.

                                                                  Control1..1
                                                                  TypeCoding
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Requirements

                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  138. Observation.code.coding:MDCType.id
                                                                  Definition

                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  ShortUnique id for inter-element referencing
                                                                  Control0..1
                                                                  Typeid
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  140. Observation.code.coding:MDCType.extension
                                                                  Definition

                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                  ShortAdditional content defined by implementations
                                                                  Comments

                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                  Control0..*
                                                                  TypeExtension
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Alternate Namesextensions, user content
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 142. Observation.code.coding:MDCType.system
                                                                    Definition

                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                    ShortIdentity of the terminology system
                                                                    Comments

                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                    Control1..1
                                                                    Typeuri
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                    Fixed Valueurn:iso:std:iso:11073:10101
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    144. Observation.code.coding:MDCType.version
                                                                    Definition

                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                    ShortVersion of the system - if relevant
                                                                    Comments

                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    146. Observation.code.coding:MDCType.code
                                                                    Definition

                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                    ShortSymbol in syntax defined by the system
                                                                    Comments

                                                                    Required for all measurements

                                                                    Control1..1
                                                                    Typecode
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to refer to a particular code in the system.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    148. Observation.code.coding:MDCType.display
                                                                    Definition

                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                    ShortRepresentation defined by the system
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    150. Observation.code.coding:MDCType.userSelected
                                                                    Definition

                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                    ShortIf this coding was chosen directly by the user
                                                                    Comments

                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                    Control0..1
                                                                    Typeboolean
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    152. Observation.code.coding:LoincCoding
                                                                    Slice NameLoincCoding
                                                                    Definition

                                                                    This LOINC code expresses what the measurement is

                                                                    ShortThe LOINC code for the measurement
                                                                    Comments

                                                                    If the observation is one of the FHIR-defined vital signs observation, the equivalent LOINC code for that vital sign as specified by FHIR appears here.

                                                                    Control0..1
                                                                    TypeCoding
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Requirements

                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    154. Observation.code.coding:LoincCoding.id
                                                                    Definition

                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typeid
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    156. Observation.code.coding:LoincCoding.extension
                                                                    Definition

                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                    ShortAdditional content defined by implementations
                                                                    Comments

                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate Namesextensions, user content
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 158. Observation.code.coding:LoincCoding.system
                                                                      Definition

                                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                                      ShortIdentity of the terminology system
                                                                      Comments

                                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                      Control1..1
                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                                      Fixed Valuehttp://loinc.org
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      160. Observation.code.coding:LoincCoding.version
                                                                      Definition

                                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                      ShortVersion of the system - if relevant
                                                                      Comments

                                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      162. Observation.code.coding:LoincCoding.code
                                                                      Definition

                                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                      ShortSymbol in syntax defined by the system
                                                                      Comments

                                                                      Required if the measurement is a vital sign

                                                                      Control1..1
                                                                      Typecode
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      Need to refer to a particular code in the system.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      164. Observation.code.coding:LoincCoding.display
                                                                      Definition

                                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                                      ShortRepresentation defined by the system
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      166. Observation.code.coding:LoincCoding.userSelected
                                                                      Definition

                                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                      ShortIf this coding was chosen directly by the user
                                                                      Comments

                                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                      Control0..1
                                                                      Typeboolean
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      168. Observation.code.text
                                                                      Definition

                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                      ShortIt is recommended to display at least the reference identifier for the MDC code
                                                                      Comments

                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      170. Observation.subject
                                                                      Definition

                                                                      The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

                                                                      ShortWho and/or what the observation is about
                                                                      Comments

                                                                      One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                                                                      Control1..1
                                                                      TypeReference(Patient, Group, Device, Location, Organization, Procedure, Practitioner, Medication, Substance)
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summarytrue
                                                                      Requirements

                                                                      Observations have no value if you don't know who or what they're about.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      172. Observation.subject.id
                                                                      Definition

                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typeid
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      174. Observation.subject.extension
                                                                      Definition

                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                      ShortAdditional content defined by implementations
                                                                      Comments

                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      SlicingThis element introduces a set of slices on Observation.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 176. Observation.subject.reference
                                                                        Definition

                                                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                        ShortLiteral reference, Relative, internal or absolute URL
                                                                        Comments

                                                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                        Control1..1
                                                                        This element is affected by the following invariants: ref-1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        178. Observation.subject.type
                                                                        Definition

                                                                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                        ShortType the reference refers to (e.g. "Patient")
                                                                        Comments

                                                                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                        Control0..1
                                                                        BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                        (extensible to http://hl7.org/fhir/ValueSet/resource-types)
                                                                        Typeuri
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        180. Observation.subject.identifier
                                                                        Definition

                                                                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                        ShortLogical reference, when literal reference is not known
                                                                        Comments

                                                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                        Control0..1
                                                                        TypeIdentifier
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        182. Observation.subject.display
                                                                        Definition

                                                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                                                        ShortText alternative for the resource
                                                                        Comments

                                                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        184. Observation.focus
                                                                        Definition

                                                                        The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

                                                                        ShortWhat the observation is about, when it is not about the subject of record
                                                                        Comments

                                                                        Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

                                                                        Control0..*
                                                                        TypeReference(Resource)
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        186. Observation.encounter
                                                                        Definition

                                                                        The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

                                                                        ShortHealthcare event during which this observation is made
                                                                        Comments

                                                                        This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                                                                        Control0..1
                                                                        TypeReference(Encounter)
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        For some observations it may be important to know the link between an observation and a particular encounter.

                                                                        Alternate NamesContext
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        188. Observation.effective[x]
                                                                        Definition

                                                                        The time or time-period the observed value is asserted as being true. It is a time period if a Measure-Active-Period (duration) attribute is part of the metric measurement sent by the PHD. Otherwise it is the time stamp sent by the PHD or the time of reception by the PHG if the PHD sent no time stamp.

                                                                        ShortClinically relevant time/time-period for observation
                                                                        Comments

                                                                        At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                                                        Control1..1
                                                                        TypeChoice of: dateTime, Period
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                                                                        Alternate NamesOccurrence
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        190. Observation.issued
                                                                        Definition

                                                                        The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.

                                                                        ShortDate/Time this version was made available
                                                                        Comments

                                                                        For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

                                                                        Control0..1
                                                                        Typeinstant
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        192. Observation.performer
                                                                        Definition

                                                                        Who was responsible for asserting the observed value as "true".

                                                                        ShortWho is responsible for the observation
                                                                        Control0..*
                                                                        TypeReference(Practitioner, PractitionerRole, Organization, CareTeam, Patient, RelatedPerson)
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        194. Observation.value[x]
                                                                        Definition

                                                                        The information determined as a result of making the observation, if the information has a simple value.

                                                                        ShortActual result
                                                                        Comments

                                                                        An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                        Control0..0
                                                                        This element is affected by the following invariants: obs-7
                                                                        TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supportfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        196. Observation.dataAbsentReason
                                                                        Definition

                                                                        Provides a reason why no measurement compoundComponent elements are present. This situation only happens if the Measurement-Status attribute indicates a generic error.

                                                                        ShortWhy the result is missing
                                                                        Comments

                                                                        Special values reported in the Compound-Basic/Simple-Nu-Observed-Value are handled individually in each compoundComponent element and are not considered generic. The Compound-Nu-Observed-Value has its own status entry and it is also handled in the component elements representing the compound.

                                                                        Control0..1
                                                                        This element is affected by the following invariants: obs-6
                                                                        BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                        (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                                                        Codes specifying why the result (Observation.value[x]) is missing.

                                                                        TypeCodeableConcept
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Summaryfalse
                                                                        Requirements

                                                                        For many results it is necessary to handle exceptional values in measurements.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        198. Observation.dataAbsentReason.id
                                                                        Definition

                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typeid
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        200. Observation.dataAbsentReason.extension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                        ShortAdditional content defined by implementations
                                                                        Comments

                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Alternate Namesextensions, user content
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        SlicingThis element introduces a set of slices on Observation.dataAbsentReason.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 202. Observation.dataAbsentReason.coding
                                                                          Definition

                                                                          A reference to a code defined by a terminology system.

                                                                          ShortCode defined by a terminology system
                                                                          Comments

                                                                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                          Control1..*
                                                                          TypeCoding
                                                                          Is Modifierfalse
                                                                          Summarytrue
                                                                          Requirements

                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          SlicingThis element introduces a set of slices on Observation.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ system
                                                                          • 204. Observation.dataAbsentReason.coding:FhirDefault
                                                                            Slice NameFhirDefault
                                                                            Definition

                                                                            A reference to a code defined by a terminology system.

                                                                            ShortCode defined by a terminology system
                                                                            Comments

                                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                            Control1..1
                                                                            TypeCoding
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Requirements

                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            206. Observation.dataAbsentReason.coding:FhirDefault.id
                                                                            Definition

                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                            ShortUnique id for inter-element referencing
                                                                            Control0..1
                                                                            Typeid
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            208. Observation.dataAbsentReason.coding:FhirDefault.extension
                                                                            Definition

                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                            ShortAdditional content defined by implementations
                                                                            Comments

                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Alternate Namesextensions, user content
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            SlicingThis element introduces a set of slices on Observation.dataAbsentReason.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 210. Observation.dataAbsentReason.coding:FhirDefault.system
                                                                              Definition

                                                                              The identification of the code system that defines the meaning of the symbol in the code.

                                                                              ShortIdentity of the terminology system
                                                                              Comments

                                                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                              Control1..1
                                                                              Typeuri
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need to be unambiguous about the source of the definition of the symbol.

                                                                              Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              212. Observation.dataAbsentReason.coding:FhirDefault.version
                                                                              Definition

                                                                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                              ShortVersion of the system - if relevant
                                                                              Comments

                                                                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              214. Observation.dataAbsentReason.coding:FhirDefault.code
                                                                              Definition

                                                                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                              ShortSymbol in syntax defined by the system
                                                                              Control1..1
                                                                              Typecode
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need to refer to a particular code in the system.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              216. Observation.dataAbsentReason.coding:FhirDefault.display
                                                                              Definition

                                                                              A representation of the meaning of the code in the system, following the rules of the system.

                                                                              ShortRepresentation defined by the system
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              218. Observation.dataAbsentReason.coding:FhirDefault.userSelected
                                                                              Definition

                                                                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                              ShortIf this coding was chosen directly by the user
                                                                              Comments

                                                                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                              Control0..1
                                                                              Typeboolean
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              220. Observation.dataAbsentReason.text
                                                                              Definition

                                                                              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                              ShortPlain text representation of the concept
                                                                              Comments

                                                                              Very often the text is the same as a displayName of one of the codings.

                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              222. Observation.interpretation
                                                                              Definition

                                                                              A categorical assessment of an observation value. For example, high, low, normal.

                                                                              ShortHigh, low, normal, etc.
                                                                              Comments

                                                                              Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                              Control0..*
                                                                              BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                              (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                              Codes identifying interpretations of observations.

                                                                              TypeCodeableConcept
                                                                              Is Modifierfalse
                                                                              Must Supportfalse
                                                                              Summaryfalse
                                                                              Requirements

                                                                              For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                              Alternate NamesAbnormal Flag
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              224. Observation.interpretation.id
                                                                              Definition

                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                              ShortUnique id for inter-element referencing
                                                                              Control0..1
                                                                              Typeid
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              226. Observation.interpretation.extension
                                                                              Definition

                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                              ShortAdditional content defined by implementations
                                                                              Comments

                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                              Control0..*
                                                                              TypeExtension
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Alternate Namesextensions, user content
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              SlicingThis element introduces a set of slices on Observation.interpretation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 228. Observation.interpretation.coding
                                                                                Definition

                                                                                A reference to a code defined by a terminology system.

                                                                                ShortCode defined by a terminology system
                                                                                Comments

                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                Control1..*
                                                                                TypeCoding
                                                                                Is Modifierfalse
                                                                                Summarytrue
                                                                                Requirements

                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ system
                                                                                • 230. Observation.interpretation.coding:MsmtStatusInterpretation
                                                                                  Slice NameMsmtStatusInterpretation
                                                                                  Definition

                                                                                  A reference to a code defined by a terminology system.

                                                                                  ShortMeasurement status interpretation when questionable, calibration-ongoing, validated, early-indication, threshold exceeded, alarm inhibited
                                                                                  Comments

                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                  Control1..1
                                                                                  TypeCoding
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  232. Observation.interpretation.coding:MsmtStatusInterpretation.id
                                                                                  Definition

                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typeid
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  234. Observation.interpretation.coding:MsmtStatusInterpretation.extension
                                                                                  Definition

                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                  • value @ url
                                                                                  • 236. Observation.interpretation.coding:MsmtStatusInterpretation.system
                                                                                    Definition

                                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                                    ShortIdentity of the terminology system
                                                                                    Comments

                                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                    Control1..1
                                                                                    Typeuri
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                                    Fixed Valuehttp://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    238. Observation.interpretation.coding:MsmtStatusInterpretation.version
                                                                                    Definition

                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                    ShortVersion of the system - if relevant
                                                                                    Comments

                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    240. Observation.interpretation.coding:MsmtStatusInterpretation.code
                                                                                    Definition

                                                                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                    ShortSymbol in syntax defined by the system
                                                                                    Control1..1
                                                                                    Typecode
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Need to refer to a particular code in the system.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    242. Observation.interpretation.coding:MsmtStatusInterpretation.display
                                                                                    Definition

                                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                                    ShortRepresentation defined by the system
                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    244. Observation.interpretation.coding:MsmtStatusInterpretation.userSelected
                                                                                    Definition

                                                                                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                    ShortIf this coding was chosen directly by the user
                                                                                    Comments

                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                    Control0..1
                                                                                    Typeboolean
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    246. Observation.interpretation.text
                                                                                    Definition

                                                                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                    ShortPlain text representation of the concept
                                                                                    Comments

                                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    248. Observation.note
                                                                                    Definition

                                                                                    Comments about the observation or the results.

                                                                                    ShortComments about the observation
                                                                                    Comments

                                                                                    May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                                                                                    Control0..*
                                                                                    TypeAnnotation
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Summaryfalse
                                                                                    Requirements

                                                                                    Need to be able to provide free text additional information.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    250. Observation.bodySite
                                                                                    Definition

                                                                                    Indicates the site on the subject's body where the observation was made (i.e. the target site).

                                                                                    ShortObserved body part
                                                                                    Comments

                                                                                    Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                                                    If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                                                                                    Control0..1
                                                                                    BindingFor example codes, see SNOMEDCTBodyStructures
                                                                                    (example to http://hl7.org/fhir/ValueSet/body-site)

                                                                                    SNOMED CT Body site concepts

                                                                                    TypeCodeableConcept
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    252. Observation.method
                                                                                    Definition

                                                                                    Indicates the mechanism used to perform the observation.

                                                                                    ShortHow it was done
                                                                                    Comments

                                                                                    Only used if not implicit in code for Observation.code.

                                                                                    Control0..1
                                                                                    BindingFor example codes, see ObservationMethods
                                                                                    (example to http://hl7.org/fhir/ValueSet/observation-methods)

                                                                                    Methods for simple observations.

                                                                                    TypeCodeableConcept
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Summaryfalse
                                                                                    Requirements

                                                                                    In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    254. Observation.specimen
                                                                                    Definition

                                                                                    The specimen that was used when this observation was made.

                                                                                    ShortSpecimen used for this observation
                                                                                    Comments

                                                                                    Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                                                                                    Control0..1
                                                                                    TypeReference(Specimen)
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    256. Observation.device
                                                                                    Definition

                                                                                    The device used to generate the observation data.

                                                                                    Short(Measurement) Device
                                                                                    Comments

                                                                                    This field will reference the PHD Device.

                                                                                    Control1..1
                                                                                    TypeReference(Device, DeviceMetric)
                                                                                    Is Modifierfalse
                                                                                    Must Supportfalse
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    258. Observation.device.id
                                                                                    Definition

                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                    ShortUnique id for inter-element referencing
                                                                                    Control0..1
                                                                                    Typeid
                                                                                    Is Modifierfalse
                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                    Summaryfalse
                                                                                    260. Observation.device.extension
                                                                                    Definition

                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                    ShortAdditional content defined by implementations
                                                                                    Comments

                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                    Control0..*
                                                                                    TypeExtension
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesextensions, user content
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    SlicingThis element introduces a set of slices on Observation.device.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 262. Observation.device.reference
                                                                                      Definition

                                                                                      Reference to the device-related resources that describe the sensor device taking the measurement. This element will point to a Device resource following the Phd Device Profile.

                                                                                      ShortReference to the device responsible for the measurement
                                                                                      Comments

                                                                                      This reference points to the Device resource containing information about the sensor device that took the measurement.

                                                                                      Control1..1
                                                                                      This element is affected by the following invariants: ref-1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      264. Observation.device.type
                                                                                      Definition

                                                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                      ShortType the reference refers to (e.g. "Patient")
                                                                                      Comments

                                                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                      Control0..1
                                                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types)
                                                                                      Typeuri
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      266. Observation.device.identifier
                                                                                      Definition

                                                                                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                      ShortLogical reference, when literal reference is not known
                                                                                      Comments

                                                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                      Control0..1
                                                                                      TypeIdentifier
                                                                                      Is Modifierfalse
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      268. Observation.device.display
                                                                                      Definition

                                                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                      ShortText alternative for the resource
                                                                                      Comments

                                                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      270. Observation.referenceRange
                                                                                      Definition

                                                                                      Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

                                                                                      ShortProvides guide for interpretation
                                                                                      Comments

                                                                                      Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                      Control0..*
                                                                                      TypeBackboneElement
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Requirements

                                                                                      Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                                                      obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                                                                      272. Observation.referenceRange.id
                                                                                      Definition

                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                      ShortUnique id for inter-element referencing
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                      Summaryfalse
                                                                                      274. Observation.referenceRange.extension
                                                                                      Definition

                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                      ShortAdditional content defined by implementations
                                                                                      Comments

                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Is Modifierfalse
                                                                                      Summaryfalse
                                                                                      Alternate Namesextensions, user content
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      276. Observation.referenceRange.modifierExtension
                                                                                      Definition

                                                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                                      Comments

                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                      Alternate Namesextensions, user content, modifiers
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      278. Observation.referenceRange.low
                                                                                      Definition

                                                                                      The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

                                                                                      ShortLow Range, if relevant
                                                                                      Control0..1
                                                                                      This element is affected by the following invariants: obs-3
                                                                                      TypeQuantity(SimpleQuantity)
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      280. Observation.referenceRange.high
                                                                                      Definition

                                                                                      The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

                                                                                      ShortHigh Range, if relevant
                                                                                      Control0..1
                                                                                      This element is affected by the following invariants: obs-3
                                                                                      TypeQuantity(SimpleQuantity)
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      282. Observation.referenceRange.type
                                                                                      Definition

                                                                                      Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

                                                                                      ShortReference range qualifier
                                                                                      Comments

                                                                                      This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

                                                                                      Control0..1
                                                                                      BindingThe codes SHOULD be taken from ObservationReferenceRangeMeaningCodes
                                                                                      (preferred to http://hl7.org/fhir/ValueSet/referencerange-meaning)

                                                                                      Code for the meaning of a reference range.

                                                                                      TypeCodeableConcept
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Requirements

                                                                                      Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      284. Observation.referenceRange.appliesTo
                                                                                      Definition

                                                                                      Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

                                                                                      ShortReference range population
                                                                                      Comments

                                                                                      This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

                                                                                      Control0..*
                                                                                      BindingFor example codes, see ObservationReferenceRangeAppliesToCodes
                                                                                      (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto)

                                                                                      Codes identifying the population the reference range applies to.

                                                                                      TypeCodeableConcept
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Requirements

                                                                                      Need to be able to identify the target population for proper interpretation.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      286. Observation.referenceRange.age
                                                                                      Definition

                                                                                      The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

                                                                                      ShortApplicable age range, if relevant
                                                                                      Control0..1
                                                                                      TypeRange
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Requirements

                                                                                      Some analytes vary greatly over age.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      288. Observation.referenceRange.text
                                                                                      Definition

                                                                                      Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".

                                                                                      ShortText based reference range in an observation
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Must Supportfalse
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      290. Observation.hasMember
                                                                                      Definition

                                                                                      This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

                                                                                      ShortRelated resource that belongs to the Observation group
                                                                                      Comments

                                                                                      When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

                                                                                      Control0..*
                                                                                      TypeReference(Observation, QuestionnaireResponse, MolecularSequence)
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      292. Observation.derivedFrom
                                                                                      Definition

                                                                                      The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.

                                                                                      ShortReference to the Coincident Time Stamp Observation and/or Source-Handle-Reference Observation
                                                                                      Comments

                                                                                      When the PHD reports a time stamp a reference to the Coincident Time Stamp Observation is placed here. When the PHD reports a Source-Handle-Reference/-List attribute the Observation(s) pointed to by that Source-Handle-Reference/-List is (are) placed here. One may end up with several Observation.derivedFrom elements.

                                                                                      Control0..*
                                                                                      TypeReference(DocumentReference, ImagingStudy, Media, QuestionnaireResponse, Observation, MolecularSequence)
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      294. Observation.component
                                                                                      Definition

                                                                                      Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                                      ShortComponent results
                                                                                      Comments

                                                                                      For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                                      Control0..*
                                                                                      TypeBackboneElement
                                                                                      Is Modifierfalse
                                                                                      Must Supportfalse
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                                                      SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ code
                                                                                      • 296. Observation.component.id
                                                                                        Definition

                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        298. Observation.component.extension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Alternate Namesextensions, user content
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        300. Observation.component.modifierExtension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                        Alternate Namesextensions, user content, modifiers
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        302. Observation.component.code
                                                                                        Definition

                                                                                        Describes what was observed. Sometimes this is called the observation "code".

                                                                                        ShortType of component observation (code / type)
                                                                                        Comments

                                                                                        All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                        Control1..1
                                                                                        BindingFor example codes, see LOINCCodes
                                                                                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                                        Codes identifying names of simple observations.

                                                                                        TypeCodeableConcept
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        304. Observation.component.value[x]
                                                                                        Definition

                                                                                        The information determined as a result of making the observation, if the information has a simple value.

                                                                                        ShortActual component result
                                                                                        Comments

                                                                                        Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                        Control0..1
                                                                                        TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supportfalse
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        306. Observation.component.dataAbsentReason
                                                                                        Definition

                                                                                        Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                                                                        ShortWhy the component result is missing
                                                                                        Comments

                                                                                        "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                                                                        The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                                                                        Control0..1
                                                                                        This element is affected by the following invariants: obs-6
                                                                                        BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                        (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                                                                        Codes specifying why the result (Observation.value[x]) is missing.

                                                                                        TypeCodeableConcept
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summaryfalse
                                                                                        Requirements

                                                                                        For many results it is necessary to handle exceptional values in measurements.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        308. Observation.component.interpretation
                                                                                        Definition

                                                                                        A categorical assessment of an observation value. For example, high, low, normal.

                                                                                        ShortHigh, low, normal, etc.
                                                                                        Comments

                                                                                        Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                        Control0..*
                                                                                        BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                                        Codes identifying interpretations of observations.

                                                                                        TypeCodeableConcept
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summaryfalse
                                                                                        Requirements

                                                                                        For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                        Alternate NamesAbnormal Flag
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        310. Observation.component.referenceRange
                                                                                        Definition

                                                                                        Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                                        ShortProvides guide for interpretation of component result
                                                                                        Comments

                                                                                        Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                        Control0..*
                                                                                        TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summaryfalse
                                                                                        Requirements

                                                                                        Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        312. Observation.component:supplementalTypesComponent
                                                                                        Slice NamesupplementalTypesComponent
                                                                                        Definition

                                                                                        For each partition:term code pair contained in the Supplemental-Types attribute, a separate supplementalTypesComponent element is generated. The component is not generated if the attribute is absent or empty. The component shall be generated otherwise.

                                                                                        ShortSupplemental Type: A further description of the measurement type.
                                                                                        Comments

                                                                                        A PHD may send a Supplemental-Types attribute as part of the measurement. This attribute consists of a set of MDC nomenclature codes as partition:term code pairs. Each pair is a code describing something additional about the measurement, such as MDC_MODALITY_SPOT in the pulse oximeter which indicates that the provided measurement is a stable average. An MDC_MODALITY_FAST would indicate that a short averaging is used and the result reported regardless of stability.

                                                                                        Control0..*
                                                                                        TypeBackboneElement
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                                                        314. Observation.component:supplementalTypesComponent.id
                                                                                        Definition

                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        316. Observation.component:supplementalTypesComponent.extension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Alternate Namesextensions, user content
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        318. Observation.component:supplementalTypesComponent.modifierExtension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                        Alternate Namesextensions, user content, modifiers
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        320. Observation.component:supplementalTypesComponent.code
                                                                                        Definition

                                                                                        Describes what was observed. Sometimes this is called the observation "code".

                                                                                        ShortType of component observation (code / type)
                                                                                        Comments

                                                                                        All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                        Control1..1
                                                                                        BindingThe codes SHALL be taken from CodeableConcept 11073 Attributes
                                                                                        (required to http://hl7.org/fhir/uv/phd/ValueSet/CodeableConcept11073MDC)
                                                                                        TypeCodeableConcept
                                                                                        Is Modifierfalse
                                                                                        Must Supportfalse
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        322. Observation.component:supplementalTypesComponent.code.id
                                                                                        Definition

                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typeid
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        324. Observation.component:supplementalTypesComponent.code.extension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Alternate Namesextensions, user content
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • value @ url
                                                                                        • 326. Observation.component:supplementalTypesComponent.code.coding
                                                                                          Definition

                                                                                          A reference to a code defined by a terminology system.

                                                                                          ShortCode defined by a terminology system
                                                                                          Comments

                                                                                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                          Control1..*
                                                                                          TypeCoding
                                                                                          Is Modifierfalse
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                          • value @ system
                                                                                          • 328. Observation.component:supplementalTypesComponent.code.coding:MdcType
                                                                                            Slice NameMdcType
                                                                                            Definition

                                                                                            A reference to a code defined by a terminology system.

                                                                                            ShortThe 11073-10101 MDC code for the measurement
                                                                                            Comments

                                                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                            Control1..1
                                                                                            TypeCoding
                                                                                            Is Modifierfalse
                                                                                            Summarytrue
                                                                                            Requirements

                                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            330. Observation.component:supplementalTypesComponent.code.coding:MdcType.id
                                                                                            Definition

                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                            ShortUnique id for inter-element referencing
                                                                                            Control0..1
                                                                                            Typeid
                                                                                            Is Modifierfalse
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Summaryfalse
                                                                                            332. Observation.component:supplementalTypesComponent.code.coding:MdcType.extension
                                                                                            Definition

                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                            ShortAdditional content defined by implementations
                                                                                            Comments

                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                            Control0..*
                                                                                            TypeExtension
                                                                                            Is Modifierfalse
                                                                                            Summaryfalse
                                                                                            Alternate Namesextensions, user content
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                            SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                            • value @ url
                                                                                            • 334. Observation.component:supplementalTypesComponent.code.coding:MdcType.system
                                                                                              Definition

                                                                                              The identification of the code system that defines the meaning of the symbol in the code.

                                                                                              ShortIdentity of the terminology system
                                                                                              Comments

                                                                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                              Control1..1
                                                                                              Typeuri
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              Need to be unambiguous about the source of the definition of the symbol.

                                                                                              Fixed Valueurn:iso:std:iso:11073:10101
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              336. Observation.component:supplementalTypesComponent.code.coding:MdcType.version
                                                                                              Definition

                                                                                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                              ShortVersion of the system - if relevant
                                                                                              Comments

                                                                                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              338. Observation.component:supplementalTypesComponent.code.coding:MdcType.code
                                                                                              Definition

                                                                                              68193 is the 32-bit nomenclature code indicating a 'Supplemental-Types' value

                                                                                              ShortSymbol in syntax defined by the system
                                                                                              Control1..1
                                                                                              Typecode
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              Need to refer to a particular code in the system.

                                                                                              Fixed Value68193
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              340. Observation.component:supplementalTypesComponent.code.coding:MdcType.display
                                                                                              Definition

                                                                                              A representation of the meaning of the code in the system, following the rules of the system.

                                                                                              ShortRepresentation defined by the system
                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              342. Observation.component:supplementalTypesComponent.code.coding:MdcType.userSelected
                                                                                              Definition

                                                                                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                              ShortIf this coding was chosen directly by the user
                                                                                              Comments

                                                                                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                              Control0..1
                                                                                              Typeboolean
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              344. Observation.component:supplementalTypesComponent.code.text
                                                                                              Definition

                                                                                              It is recommended to display at least the reference identifier for the Supplemental-Types which is MDC_ATTR_SUPPLEMENTAL_TYPES

                                                                                              ShortPlain text representation of the concept
                                                                                              Comments

                                                                                              Very often the text is the same as a displayName of one of the codings.

                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Is Modifierfalse
                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              346. Observation.component:supplementalTypesComponent.value[x]
                                                                                              Definition

                                                                                              The information determined as a result of making the observation, if the information has a simple value.

                                                                                              ShortActual component result
                                                                                              Comments

                                                                                              Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                              Control1..1
                                                                                              TypeCodeableConcept
                                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                              Is Modifierfalse
                                                                                              Must Supportfalse
                                                                                              Summarytrue
                                                                                              Requirements

                                                                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                              • type @ $this
                                                                                              • 348. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept
                                                                                                Slice NamevalueCodeableConcept
                                                                                                Definition

                                                                                                The supplemental information determined as a result of making the observation, if the information is a code.

                                                                                                ShortActual component result
                                                                                                Comments

                                                                                                Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                Control1..1
                                                                                                TypeCodeableConcept
                                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                Is Modifierfalse
                                                                                                Must Supportfalse
                                                                                                Summarytrue
                                                                                                Requirements

                                                                                                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                350. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.id
                                                                                                Definition

                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                ShortUnique id for inter-element referencing
                                                                                                Control0..1
                                                                                                Typeid
                                                                                                Is Modifierfalse
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                Summaryfalse
                                                                                                352. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.extension
                                                                                                Definition

                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                ShortAdditional content defined by implementations
                                                                                                Comments

                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                Control0..*
                                                                                                TypeExtension
                                                                                                Is Modifierfalse
                                                                                                Summaryfalse
                                                                                                Alternate Namesextensions, user content
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • value @ url
                                                                                                • 354. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding
                                                                                                  Definition

                                                                                                  A reference to a code defined by a terminology system.

                                                                                                  ShortCode defined by a terminology system
                                                                                                  Comments

                                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                  Control1..*
                                                                                                  TypeCoding
                                                                                                  Is Modifierfalse
                                                                                                  Summarytrue
                                                                                                  Requirements

                                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  SlicingThis element introduces a set of slices on Observation.component.value[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                  • value @ system
                                                                                                  • 356. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType
                                                                                                    Slice NameMDCType
                                                                                                    Definition

                                                                                                    A reference to a code defined by a terminology system.

                                                                                                    ShortRequired MDC code entry.
                                                                                                    Comments

                                                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                    Control1..1
                                                                                                    TypeCoding
                                                                                                    Is Modifierfalse
                                                                                                    Summarytrue
                                                                                                    Requirements

                                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    358. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.id
                                                                                                    Definition

                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                    ShortUnique id for inter-element referencing
                                                                                                    Control0..1
                                                                                                    Typeid
                                                                                                    Is Modifierfalse
                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                    Summaryfalse
                                                                                                    360. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.extension
                                                                                                    Definition

                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                    ShortAdditional content defined by implementations
                                                                                                    Comments

                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                    Control0..*
                                                                                                    TypeExtension
                                                                                                    Is Modifierfalse
                                                                                                    Summaryfalse
                                                                                                    Alternate Namesextensions, user content
                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                    SlicingThis element introduces a set of slices on Observation.component.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                    • value @ url
                                                                                                    • 362. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.system
                                                                                                      Definition

                                                                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                      ShortIdentity of the terminology system
                                                                                                      Comments

                                                                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                      Control1..1
                                                                                                      Typeuri
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                                                                      Fixed Valueurn:iso:std:iso:11073:10101
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      364. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.version
                                                                                                      Definition

                                                                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                      ShortVersion of the system - if relevant
                                                                                                      Comments

                                                                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      366. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.code
                                                                                                      Definition

                                                                                                      For the given Supplemental-Types entry the code here is given by: partition * 2**16 + term code

                                                                                                      ShortSymbol in syntax defined by the system
                                                                                                      Control1..1
                                                                                                      Typecode
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need to refer to a particular code in the system.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      368. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.display
                                                                                                      Definition

                                                                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                      ShortRepresentation defined by the system
                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      370. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:MDCType.userSelected
                                                                                                      Definition

                                                                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                      ShortIf this coding was chosen directly by the user
                                                                                                      Comments

                                                                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                      Control0..1
                                                                                                      Typeboolean
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      372. Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.text
                                                                                                      Definition

                                                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                      ShortPlain text representation of the concept
                                                                                                      Comments

                                                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      374. Observation.component:supplementalTypesComponent.dataAbsentReason
                                                                                                      Definition

                                                                                                      Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                                                                                      ShortWhy the component result is missing
                                                                                                      Comments

                                                                                                      "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                                                                                      The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                                                                                      Control0..0
                                                                                                      This element is affected by the following invariants: obs-6
                                                                                                      BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                                                                                      Codes specifying why the result (Observation.value[x]) is missing.

                                                                                                      TypeCodeableConcept
                                                                                                      Is Modifierfalse
                                                                                                      Must Supportfalse
                                                                                                      Summaryfalse
                                                                                                      Requirements

                                                                                                      For many results it is necessary to handle exceptional values in measurements.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      376. Observation.component:supplementalTypesComponent.interpretation
                                                                                                      Definition

                                                                                                      A categorical assessment of an observation value. For example, high, low, normal.

                                                                                                      ShortHigh, low, normal, etc.
                                                                                                      Comments

                                                                                                      Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                                      Control0..*
                                                                                                      BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                                                      Codes identifying interpretations of observations.

                                                                                                      TypeCodeableConcept
                                                                                                      Is Modifierfalse
                                                                                                      Must Supportfalse
                                                                                                      Summaryfalse
                                                                                                      Requirements

                                                                                                      For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                                      Alternate NamesAbnormal Flag
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      378. Observation.component:supplementalTypesComponent.referenceRange
                                                                                                      Definition

                                                                                                      Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                                                      ShortProvides guide for interpretation of component result
                                                                                                      Comments

                                                                                                      Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                                      Control0..*
                                                                                                      TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                                      Is Modifierfalse
                                                                                                      Must Supportfalse
                                                                                                      Summaryfalse
                                                                                                      Requirements

                                                                                                      Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      380. Observation.component:compound
                                                                                                      Slice Namecompound
                                                                                                      Definition

                                                                                                      Each compoundComponent contains one of the N constituents of the compound measurement. These entries are NOT present if a Measurement-Status attribute indicates an error.

                                                                                                      ShortCompound numeric measurement entry components
                                                                                                      Comments

                                                                                                      A compound measurement is a measurement that requires more than one value to represent it, such as an acceleration which has an x, y, and z components. The Blood pressure is also represented as a compound measurement, containing systolic, diastolic and MAP components. One combines all the compound elements together to describe the measurement. The Metric-Id-List entry n and Compound-Basic/Simple-Nu-Observed-Value entry n are ordered such that the code that describes each entry n is computed from the partition of the Type attribute and the term code of the Metric-Id-List attribute. In the case of the Compound-Nu-Observed-Value, the term code comes from the Compound-Nu-Observed-Value.metric sub-component.

                                                                                                      Control0..*
                                                                                                      TypeBackboneElement
                                                                                                      Is Modifierfalse
                                                                                                      Must Supportfalse
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                                                                      382. Observation.component:compound.id
                                                                                                      Definition

                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                      ShortUnique id for inter-element referencing
                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                      Summaryfalse
                                                                                                      384. Observation.component:compound.extension
                                                                                                      Definition

                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                      ShortAdditional content defined by implementations
                                                                                                      Comments

                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                      Control0..*
                                                                                                      TypeExtension
                                                                                                      Is Modifierfalse
                                                                                                      Summaryfalse
                                                                                                      Alternate Namesextensions, user content
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                      386. Observation.component:compound.modifierExtension
                                                                                                      Definition

                                                                                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                                                      Comments

                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                      Control0..*
                                                                                                      TypeExtension
                                                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                      Alternate Namesextensions, user content, modifiers
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                      388. Observation.component:compound.code
                                                                                                      Definition

                                                                                                      Describes what was observed. Sometimes this is called the observation "code".

                                                                                                      ShortType of component observation (code / type)
                                                                                                      Comments

                                                                                                      All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                                      Control1..1
                                                                                                      BindingThe codes SHALL be taken from 11073 MDC Non-Object codes
                                                                                                      (required to http://hl7.org/fhir/uv/phd/ValueSet/MDCnotObject)
                                                                                                      TypeCodeableConcept
                                                                                                      Is Modifierfalse
                                                                                                      Must Supportfalse
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      390. Observation.component:compound.code.id
                                                                                                      Definition

                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                      ShortUnique id for inter-element referencing
                                                                                                      Control0..1
                                                                                                      Typeid
                                                                                                      Is Modifierfalse
                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                      Summaryfalse
                                                                                                      392. Observation.component:compound.code.extension
                                                                                                      Definition

                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                      ShortAdditional content defined by implementations
                                                                                                      Comments

                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                      Control0..*
                                                                                                      TypeExtension
                                                                                                      Is Modifierfalse
                                                                                                      Summaryfalse
                                                                                                      Alternate Namesextensions, user content
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                      SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                      • value @ url
                                                                                                      • 394. Observation.component:compound.code.coding
                                                                                                        Definition

                                                                                                        A reference to a code defined by a terminology system.

                                                                                                        ShortCode defined by a terminology system
                                                                                                        Comments

                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                        Control1..*
                                                                                                        TypeCoding
                                                                                                        Is Modifierfalse
                                                                                                        Summarytrue
                                                                                                        Requirements

                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                        SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                        • value @ system
                                                                                                        • 396. Observation.component:compound.code.coding:MdcType
                                                                                                          Slice NameMdcType
                                                                                                          Definition

                                                                                                          This MDC code expresses what the measurement is

                                                                                                          ShortThe 11073-10101 MDC code for the measurement
                                                                                                          Comments

                                                                                                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                          Control1..1
                                                                                                          TypeCoding
                                                                                                          Is Modifierfalse
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          398. Observation.component:compound.code.coding:MdcType.id
                                                                                                          Definition

                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                          ShortUnique id for inter-element referencing
                                                                                                          Control0..1
                                                                                                          Typeid
                                                                                                          Is Modifierfalse
                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                          Summaryfalse
                                                                                                          400. Observation.component:compound.code.coding:MdcType.extension
                                                                                                          Definition

                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                          ShortAdditional content defined by implementations
                                                                                                          Comments

                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                          Control0..*
                                                                                                          TypeExtension
                                                                                                          Is Modifierfalse
                                                                                                          Summaryfalse
                                                                                                          Alternate Namesextensions, user content
                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                          SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                          • value @ url
                                                                                                          • 402. Observation.component:compound.code.coding:MdcType.system
                                                                                                            Definition

                                                                                                            The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                            ShortIdentity of the terminology system
                                                                                                            Comments

                                                                                                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                            Control1..1
                                                                                                            Typeuri
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need to be unambiguous about the source of the definition of the symbol.

                                                                                                            Fixed Valueurn:iso:std:iso:11073:10101
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            404. Observation.component:compound.code.coding:MdcType.version
                                                                                                            Definition

                                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                            ShortVersion of the system - if relevant
                                                                                                            Comments

                                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                            Control0..1
                                                                                                            Typestring
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            406. Observation.component:compound.code.coding:MdcType.code
                                                                                                            Definition

                                                                                                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                            ShortSymbol in syntax defined by the system
                                                                                                            Control1..1
                                                                                                            Typecode
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need to refer to a particular code in the system.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            408. Observation.component:compound.code.coding:MdcType.display
                                                                                                            Definition

                                                                                                            A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                            ShortRepresentation defined by the system
                                                                                                            Control0..1
                                                                                                            Typestring
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            410. Observation.component:compound.code.coding:MdcType.userSelected
                                                                                                            Definition

                                                                                                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                            ShortIf this coding was chosen directly by the user
                                                                                                            Comments

                                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                            Control0..1
                                                                                                            Typeboolean
                                                                                                            Is Modifierfalse
                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            412. Observation.component:compound.code.coding:LoincCoding
                                                                                                            Slice NameLoincCoding
                                                                                                            Definition

                                                                                                            This (optional) LOINC code expresses what the measurement is

                                                                                                            ShortThe LOINC code for the measurement if a vital sign
                                                                                                            Comments

                                                                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                            Control0..1
                                                                                                            TypeCoding
                                                                                                            Is Modifierfalse
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            414. Observation.component:compound.code.coding:LoincCoding.id
                                                                                                            Definition

                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                            ShortUnique id for inter-element referencing
                                                                                                            Control0..1
                                                                                                            Typeid
                                                                                                            Is Modifierfalse
                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                            Summaryfalse
                                                                                                            416. Observation.component:compound.code.coding:LoincCoding.extension
                                                                                                            Definition

                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                            ShortAdditional content defined by implementations
                                                                                                            Comments

                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                            Control0..*
                                                                                                            TypeExtension
                                                                                                            Is Modifierfalse
                                                                                                            Summaryfalse
                                                                                                            Alternate Namesextensions, user content
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                            SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                            • value @ url
                                                                                                            • 418. Observation.component:compound.code.coding:LoincCoding.system
                                                                                                              Definition

                                                                                                              The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                              ShortIdentity of the terminology system
                                                                                                              Comments

                                                                                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                              Control1..1
                                                                                                              Typeuri
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              Need to be unambiguous about the source of the definition of the symbol.

                                                                                                              Fixed Valuehttp://loinc.org
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              420. Observation.component:compound.code.coding:LoincCoding.version
                                                                                                              Definition

                                                                                                              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                              ShortVersion of the system - if relevant
                                                                                                              Comments

                                                                                                              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              422. Observation.component:compound.code.coding:LoincCoding.code
                                                                                                              Definition

                                                                                                              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                              ShortSymbol in syntax defined by the system
                                                                                                              Comments

                                                                                                              Required if the measurement is a vital sign

                                                                                                              Control1..1
                                                                                                              Typecode
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              Need to refer to a particular code in the system.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              424. Observation.component:compound.code.coding:LoincCoding.display
                                                                                                              Definition

                                                                                                              A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                              ShortRepresentation defined by the system
                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              426. Observation.component:compound.code.coding:LoincCoding.userSelected
                                                                                                              Definition

                                                                                                              Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                              ShortIf this coding was chosen directly by the user
                                                                                                              Comments

                                                                                                              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                              Control0..1
                                                                                                              Typeboolean
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              428. Observation.component:compound.code.text
                                                                                                              Definition

                                                                                                              It is recommended to display at least the reference identifier describing the compound sub-element

                                                                                                              ShortPlain text representation of the concept
                                                                                                              Comments

                                                                                                              Very often the text is the same as a displayName of one of the codings.

                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              430. Observation.component:compound.value[x]
                                                                                                              Definition

                                                                                                              The information determined as a result of making the observation, if the information has a simple value.

                                                                                                              ShortActual component result
                                                                                                              Comments

                                                                                                              Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                              Control0..1
                                                                                                              TypeQuantity
                                                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                              Is Modifierfalse
                                                                                                              Must Supportfalse
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              432. Observation.component:compound.value[x].id
                                                                                                              Definition

                                                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                              ShortUnique id for inter-element referencing
                                                                                                              Control0..1
                                                                                                              Typeid
                                                                                                              Is Modifierfalse
                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                              Summaryfalse
                                                                                                              434. Observation.component:compound.value[x].extension
                                                                                                              Definition

                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                              ShortAdditional content defined by implementations
                                                                                                              Comments

                                                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                              Control0..*
                                                                                                              TypeExtension
                                                                                                              Is Modifierfalse
                                                                                                              Summaryfalse
                                                                                                              Alternate Namesextensions, user content
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                              • value @ url
                                                                                                              • 436. Observation.component:compound.value[x].value
                                                                                                                Definition

                                                                                                                The value of nth element of the compound attribute. The value element for the nth compoundComponent is missing if the attribute sends a special value or the Compound-Nu-Observed-Value status element indicates an error.

                                                                                                                ShortNumerical value (with implicit precision)
                                                                                                                Comments

                                                                                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                Control1..1
                                                                                                                Typedecimal
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                438. Observation.component:compound.value[x].comparator
                                                                                                                Definition

                                                                                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                Short< | <= | >= | > - how to understand the value
                                                                                                                Control0..1
                                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0)
                                                                                                                Typecode
                                                                                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                440. Observation.component:compound.value[x].unit
                                                                                                                Definition

                                                                                                                A human-readable form of the unit.

                                                                                                                ShortUnit representation
                                                                                                                Control0..1
                                                                                                                Typestring
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                442. Observation.component:compound.value[x].system
                                                                                                                Definition

                                                                                                                The unit code shall use the UCUM system

                                                                                                                ShortSystem that defines coded unit form
                                                                                                                Control1..1
                                                                                                                This element is affected by the following invariants: qty-3
                                                                                                                Typeuri
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need to know the system that defines the coded form of the unit.

                                                                                                                Fixed Valuehttp://unitsofmeasure.org
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                444. Observation.component:compound.value[x].code
                                                                                                                Definition

                                                                                                                The MDC code must be translated to the UCUM code.

                                                                                                                ShortCoded form of the unit
                                                                                                                Comments

                                                                                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                Control1..1
                                                                                                                Typecode
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Requirements

                                                                                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                446. Observation.component:compound.dataAbsentReason
                                                                                                                Definition

                                                                                                                Provides a reason why the expected value in the nth element Observation.compoundComponent.valueQuantity is missing. This could be a NaN (Not a Number), PINF (Positive infinity), NINF (Negative infinity) or the reserved and not-at-this-resolution special values. It can also be indicated by the (measurement) status field of the Compound-Nu-Observed-Value. Note that the FHIR codes for NAN are no longer 'NAN' but 'not-a-number'. Similar changes have been made for NINF and PINF.

                                                                                                                ShortPopulated when a special value or status in Compound-Nu-Observed-Value indicates invalid, not unavailable, or msmt ongoing
                                                                                                                Comments

                                                                                                                "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                                                                                                The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                                                                                                Control0..1
                                                                                                                This element is affected by the following invariants: obs-6
                                                                                                                BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                                (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                                                                                                Codes specifying why the result (Observation.value[x]) is missing.

                                                                                                                TypeCodeableConcept
                                                                                                                Is Modifierfalse
                                                                                                                Must Supportfalse
                                                                                                                Summaryfalse
                                                                                                                Requirements

                                                                                                                For many results it is necessary to handle exceptional values in measurements.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                448. Observation.component:compound.dataAbsentReason.id
                                                                                                                Definition

                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                Control0..1
                                                                                                                Typeid
                                                                                                                Is Modifierfalse
                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                Summaryfalse
                                                                                                                450. Observation.component:compound.dataAbsentReason.extension
                                                                                                                Definition

                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                ShortAdditional content defined by implementations
                                                                                                                Comments

                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                Control0..*
                                                                                                                TypeExtension
                                                                                                                Is Modifierfalse
                                                                                                                Summaryfalse
                                                                                                                Alternate Namesextensions, user content
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                SlicingThis element introduces a set of slices on Observation.component.dataAbsentReason.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                • value @ url
                                                                                                                • 452. Observation.component:compound.dataAbsentReason.coding
                                                                                                                  Definition

                                                                                                                  A reference to a code defined by a terminology system.

                                                                                                                  ShortCode defined by a terminology system
                                                                                                                  Comments

                                                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                  Control1..*
                                                                                                                  TypeCoding
                                                                                                                  Is Modifierfalse
                                                                                                                  Summarytrue
                                                                                                                  Requirements

                                                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  SlicingThis element introduces a set of slices on Observation.component.dataAbsentReason.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                  • value @ system
                                                                                                                  • 454. Observation.component:compound.dataAbsentReason.coding:FhirDefault
                                                                                                                    Slice NameFhirDefault
                                                                                                                    Definition

                                                                                                                    A reference to a code defined by a terminology system.

                                                                                                                    ShortCode defined by a terminology system
                                                                                                                    Comments

                                                                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                    Control1..1
                                                                                                                    TypeCoding
                                                                                                                    Is Modifierfalse
                                                                                                                    Summarytrue
                                                                                                                    Requirements

                                                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    456. Observation.component:compound.dataAbsentReason.coding:FhirDefault.id
                                                                                                                    Definition

                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                    Control0..1
                                                                                                                    Typeid
                                                                                                                    Is Modifierfalse
                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                    Summaryfalse
                                                                                                                    458. Observation.component:compound.dataAbsentReason.coding:FhirDefault.extension
                                                                                                                    Definition

                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                    Comments

                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                    Control0..*
                                                                                                                    TypeExtension
                                                                                                                    Is Modifierfalse
                                                                                                                    Summaryfalse
                                                                                                                    Alternate Namesextensions, user content
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                    SlicingThis element introduces a set of slices on Observation.component.dataAbsentReason.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                    • value @ url
                                                                                                                    • 460. Observation.component:compound.dataAbsentReason.coding:FhirDefault.system
                                                                                                                      Definition

                                                                                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                      ShortIdentity of the terminology system
                                                                                                                      Comments

                                                                                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                      Control1..1
                                                                                                                      Typeuri
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Requirements

                                                                                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                      Fixed Valuehttp://terminology.hl7.org/CodeSystem/data-absent-reason
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      462. Observation.component:compound.dataAbsentReason.coding:FhirDefault.version
                                                                                                                      Definition

                                                                                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                      ShortVersion of the system - if relevant
                                                                                                                      Comments

                                                                                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                      Control0..1
                                                                                                                      Typestring
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      464. Observation.component:compound.dataAbsentReason.coding:FhirDefault.code
                                                                                                                      Definition

                                                                                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                      ShortSymbol in syntax defined by the system
                                                                                                                      Control1..1
                                                                                                                      Typecode
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Requirements

                                                                                                                      Need to refer to a particular code in the system.

                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      466. Observation.component:compound.dataAbsentReason.coding:FhirDefault.display
                                                                                                                      Definition

                                                                                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                      ShortRepresentation defined by the system
                                                                                                                      Control0..1
                                                                                                                      Typestring
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Requirements

                                                                                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      468. Observation.component:compound.dataAbsentReason.coding:FhirDefault.userSelected
                                                                                                                      Definition

                                                                                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                      ShortIf this coding was chosen directly by the user
                                                                                                                      Comments

                                                                                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                      Control0..1
                                                                                                                      Typeboolean
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Requirements

                                                                                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      470. Observation.component:compound.dataAbsentReason.text
                                                                                                                      Definition

                                                                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                      ShortPlain text representation of the concept
                                                                                                                      Comments

                                                                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                                                                      Control0..1
                                                                                                                      Typestring
                                                                                                                      Is Modifierfalse
                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                      Summarytrue
                                                                                                                      Requirements

                                                                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      472. Observation.component:compound.interpretation
                                                                                                                      Definition

                                                                                                                      A categorical assessment of an observation value. For example, high, low, normal.

                                                                                                                      ShortHigh, low, normal, etc.
                                                                                                                      Comments

                                                                                                                      Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                                                      Control0..*
                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                                                                      Codes identifying interpretations of observations.

                                                                                                                      TypeCodeableConcept
                                                                                                                      Is Modifierfalse
                                                                                                                      Must Supportfalse
                                                                                                                      Summaryfalse
                                                                                                                      Requirements

                                                                                                                      For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                                                      Alternate NamesAbnormal Flag
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      474. Observation.component:compound.interpretation.id
                                                                                                                      Definition

                                                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                      Control0..1
                                                                                                                      Typeid
                                                                                                                      Is Modifierfalse
                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                      Summaryfalse
                                                                                                                      476. Observation.component:compound.interpretation.extension
                                                                                                                      Definition

                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                      ShortAdditional content defined by implementations
                                                                                                                      Comments

                                                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                      Control0..*
                                                                                                                      TypeExtension
                                                                                                                      Is Modifierfalse
                                                                                                                      Summaryfalse
                                                                                                                      Alternate Namesextensions, user content
                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                      SlicingThis element introduces a set of slices on Observation.component.interpretation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                      • value @ url
                                                                                                                      • 478. Observation.component:compound.interpretation.coding
                                                                                                                        Definition

                                                                                                                        A reference to a code defined by a terminology system.

                                                                                                                        ShortCode defined by a terminology system
                                                                                                                        Comments

                                                                                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                        Control1..*
                                                                                                                        TypeCoding
                                                                                                                        Is Modifierfalse
                                                                                                                        Summarytrue
                                                                                                                        Requirements

                                                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        SlicingThis element introduces a set of slices on Observation.component.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                        • value @ system
                                                                                                                        • 480. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation
                                                                                                                          Slice NameMsmtStatusInterpretation
                                                                                                                          Definition

                                                                                                                          A reference to a code defined by a terminology system.

                                                                                                                          ShortMeasurement status interpretation when questionable, calibration-ongoing, validated, early-indication, threshold exceeded, alarm inhibited
                                                                                                                          Comments

                                                                                                                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                          Control1..1
                                                                                                                          TypeCoding
                                                                                                                          Is Modifierfalse
                                                                                                                          Summarytrue
                                                                                                                          Requirements

                                                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          482. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.id
                                                                                                                          Definition

                                                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                          ShortUnique id for inter-element referencing
                                                                                                                          Control0..1
                                                                                                                          Typeid
                                                                                                                          Is Modifierfalse
                                                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                          Summaryfalse
                                                                                                                          484. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.extension
                                                                                                                          Definition

                                                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                          ShortAdditional content defined by implementations
                                                                                                                          Comments

                                                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                          Control0..*
                                                                                                                          TypeExtension
                                                                                                                          Is Modifierfalse
                                                                                                                          Summaryfalse
                                                                                                                          Alternate Namesextensions, user content
                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                          SlicingThis element introduces a set of slices on Observation.component.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                          • value @ url
                                                                                                                          • 486. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.system
                                                                                                                            Definition

                                                                                                                            The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                            ShortIdentity of the terminology system
                                                                                                                            Comments

                                                                                                                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                            Control1..1
                                                                                                                            Typeuri
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                            Fixed Valuehttp://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            488. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.version
                                                                                                                            Definition

                                                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                            ShortVersion of the system - if relevant
                                                                                                                            Comments

                                                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                            Control0..1
                                                                                                                            Typestring
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            490. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.code
                                                                                                                            Definition

                                                                                                                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                                                            ShortSymbol in syntax defined by the system
                                                                                                                            Control1..1
                                                                                                                            Typecode
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Need to refer to a particular code in the system.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            492. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.display
                                                                                                                            Definition

                                                                                                                            A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                            ShortRepresentation defined by the system
                                                                                                                            Control0..1
                                                                                                                            Typestring
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            494. Observation.component:compound.interpretation.coding:MsmtStatusInterpretation.userSelected
                                                                                                                            Definition

                                                                                                                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                            ShortIf this coding was chosen directly by the user
                                                                                                                            Comments

                                                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                            Control0..1
                                                                                                                            Typeboolean
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            496. Observation.component:compound.interpretation.text
                                                                                                                            Definition

                                                                                                                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                                                            ShortPlain text representation of the concept
                                                                                                                            Comments

                                                                                                                            Very often the text is the same as a displayName of one of the codings.

                                                                                                                            Control0..1
                                                                                                                            Typestring
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            498. Observation.component:compound.referenceRange
                                                                                                                            Definition

                                                                                                                            Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                                                                            ShortProvides guide for interpretation of component result
                                                                                                                            Comments

                                                                                                                            Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                                                            Control0..*
                                                                                                                            TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                                                            Is Modifierfalse
                                                                                                                            Must Supportfalse
                                                                                                                            Summaryfalse
                                                                                                                            Requirements

                                                                                                                            Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            500. Observation.component:accuracyComponent
                                                                                                                            Slice NameaccuracyComponent
                                                                                                                            Definition

                                                                                                                            This component shall be present if the Accuracy attribute is present.

                                                                                                                            ShortThe accuracy of the measurement
                                                                                                                            Comments

                                                                                                                            For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                                                                            Control0..1
                                                                                                                            TypeBackboneElement
                                                                                                                            Is Modifierfalse
                                                                                                                            Must Supportfalse
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
                                                                                                                            502. Observation.component:accuracyComponent.id
                                                                                                                            Definition

                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                            Control0..1
                                                                                                                            Typestring
                                                                                                                            Is Modifierfalse
                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                            Summaryfalse
                                                                                                                            504. Observation.component:accuracyComponent.extension
                                                                                                                            Definition

                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                            Comments

                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                            Control0..*
                                                                                                                            TypeExtension
                                                                                                                            Is Modifierfalse
                                                                                                                            Summaryfalse
                                                                                                                            Alternate Namesextensions, user content
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                            506. Observation.component:accuracyComponent.modifierExtension
                                                                                                                            Definition

                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                                                                                            Comments

                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                            Control0..*
                                                                                                                            TypeExtension
                                                                                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                                            Alternate Namesextensions, user content, modifiers
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                            508. Observation.component:accuracyComponent.code
                                                                                                                            Definition

                                                                                                                            Describes what was observed. Sometimes this is called the observation "code".

                                                                                                                            ShortType of component observation (code / type)
                                                                                                                            Comments

                                                                                                                            All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                                                            Control1..1
                                                                                                                            BindingThe codes SHALL be taken from Quantity 11073 Attributes
                                                                                                                            (required to http://hl7.org/fhir/uv/phd/ValueSet/Quantity11073MDC)
                                                                                                                            TypeCodeableConcept
                                                                                                                            Is Modifierfalse
                                                                                                                            Must Supportfalse
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            510. Observation.component:accuracyComponent.code.id
                                                                                                                            Definition

                                                                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                            ShortUnique id for inter-element referencing
                                                                                                                            Control0..1
                                                                                                                            Typeid
                                                                                                                            Is Modifierfalse
                                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                            Summaryfalse
                                                                                                                            512. Observation.component:accuracyComponent.code.extension
                                                                                                                            Definition

                                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                            ShortAdditional content defined by implementations
                                                                                                                            Comments

                                                                                                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                            Control0..*
                                                                                                                            TypeExtension
                                                                                                                            Is Modifierfalse
                                                                                                                            Summaryfalse
                                                                                                                            Alternate Namesextensions, user content
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                            SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                            • value @ url
                                                                                                                            • 514. Observation.component:accuracyComponent.code.coding
                                                                                                                              Definition

                                                                                                                              A reference to a code defined by a terminology system.

                                                                                                                              ShortCode defined by a terminology system
                                                                                                                              Comments

                                                                                                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                              Control1..*
                                                                                                                              TypeCoding
                                                                                                                              Is Modifierfalse
                                                                                                                              Summarytrue
                                                                                                                              Requirements

                                                                                                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                              SlicingThis element introduces a set of slices on Observation.component.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                              • value @ system
                                                                                                                              • 516. Observation.component:accuracyComponent.code.coding:MdcType
                                                                                                                                Slice NameMdcType
                                                                                                                                Definition

                                                                                                                                A reference to a code defined by a terminology system.

                                                                                                                                ShortThe 11073-10101 MDC code for the measurement
                                                                                                                                Comments

                                                                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                                                                Control1..1
                                                                                                                                TypeCoding
                                                                                                                                Is Modifierfalse
                                                                                                                                Summarytrue
                                                                                                                                Requirements

                                                                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                518. Observation.component:accuracyComponent.code.coding:MdcType.id
                                                                                                                                Definition

                                                                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                ShortUnique id for inter-element referencing
                                                                                                                                Control0..1
                                                                                                                                Typeid
                                                                                                                                Is Modifierfalse
                                                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                Summaryfalse
                                                                                                                                520. Observation.component:accuracyComponent.code.coding:MdcType.extension
                                                                                                                                Definition

                                                                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                ShortAdditional content defined by implementations
                                                                                                                                Comments

                                                                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                Control0..*
                                                                                                                                TypeExtension
                                                                                                                                Is Modifierfalse
                                                                                                                                Summaryfalse
                                                                                                                                Alternate Namesextensions, user content
                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                • value @ url
                                                                                                                                • 522. Observation.component:accuracyComponent.code.coding:MdcType.system
                                                                                                                                  Definition

                                                                                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                                                                                  ShortIdentity of the terminology system
                                                                                                                                  Comments

                                                                                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                                  Control1..1
                                                                                                                                  Typeuri
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                                                                                  Fixed Valueurn:iso:std:iso:11073:10101
                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  524. Observation.component:accuracyComponent.code.coding:MdcType.version
                                                                                                                                  Definition

                                                                                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                                  ShortVersion of the system - if relevant
                                                                                                                                  Comments

                                                                                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                                  Control0..1
                                                                                                                                  Typestring
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  526. Observation.component:accuracyComponent.code.coding:MdcType.code
                                                                                                                                  Definition

                                                                                                                                  The code for the Accuracy attribute is 67914

                                                                                                                                  ShortSymbol in syntax defined by the system
                                                                                                                                  Control1..1
                                                                                                                                  Typecode
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  Need to refer to a particular code in the system.

                                                                                                                                  Fixed Value67914
                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  528. Observation.component:accuracyComponent.code.coding:MdcType.display
                                                                                                                                  Definition

                                                                                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                                                                                  ShortRepresentation defined by the system
                                                                                                                                  Control0..1
                                                                                                                                  Typestring
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  530. Observation.component:accuracyComponent.code.coding:MdcType.userSelected
                                                                                                                                  Definition

                                                                                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                                                                  ShortIf this coding was chosen directly by the user
                                                                                                                                  Comments

                                                                                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                                                                  Control0..1
                                                                                                                                  Typeboolean
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  532. Observation.component:accuracyComponent.code.text
                                                                                                                                  Definition

                                                                                                                                  Should include the reference identifier for the Accuracy attribute MDC_ATTR_NU_ACCUR_MSMT

                                                                                                                                  ShortPlain text representation of the concept
                                                                                                                                  Comments

                                                                                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                                                                                  Control0..1
                                                                                                                                  Typestring
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  534. Observation.component:accuracyComponent.value[x]
                                                                                                                                  Definition

                                                                                                                                  The information determined as a result of making the observation, if the information has a simple value.

                                                                                                                                  ShortActual component result
                                                                                                                                  Comments

                                                                                                                                  Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                  Control1..1
                                                                                                                                  TypeQuantity
                                                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Must Supportfalse
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

                                                                                                                                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                                  • type @ $this
                                                                                                                                  • 536. Observation.component:accuracyComponent.value[x]:valueQuantity
                                                                                                                                    Slice NamevalueQuantity
                                                                                                                                    Definition

                                                                                                                                    The information determined as a result of making the observation, if the information has a simple value.

                                                                                                                                    ShortActual component result
                                                                                                                                    Comments

                                                                                                                                    Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                                                                    Control1..1
                                                                                                                                    TypeQuantity
                                                                                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Must Supportfalse
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    538. Observation.component:accuracyComponent.value[x]:valueQuantity.id
                                                                                                                                    Definition

                                                                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                    Control0..1
                                                                                                                                    Typeid
                                                                                                                                    Is Modifierfalse
                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                    Summaryfalse
                                                                                                                                    540. Observation.component:accuracyComponent.value[x]:valueQuantity.extension
                                                                                                                                    Definition

                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                                                                    ShortAdditional content defined by implementations
                                                                                                                                    Comments

                                                                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                                                                    Control0..*
                                                                                                                                    TypeExtension
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                    SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                                    • value @ url
                                                                                                                                    • 542. Observation.component:accuracyComponent.value[x]:valueQuantity.value
                                                                                                                                      Definition

                                                                                                                                      This is the value of the accuracy attribute. The value is Mder FLOAT encoded and shall be expressed to the precision indicated by the Mder FLOAT.

                                                                                                                                      ShortNumerical value (with implicit precision)
                                                                                                                                      Comments

                                                                                                                                      The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                                                                                      Control1..1
                                                                                                                                      Typedecimal
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      544. Observation.component:accuracyComponent.value[x]:valueQuantity.comparator
                                                                                                                                      Definition

                                                                                                                                      How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                                                                                      Short< | <= | >= | > - how to understand the value
                                                                                                                                      Control0..1
                                                                                                                                      BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.3.0)
                                                                                                                                      Typecode
                                                                                                                                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                                                                                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      546. Observation.component:accuracyComponent.value[x]:valueQuantity.unit
                                                                                                                                      Definition

                                                                                                                                      A human-readable form of the unit.

                                                                                                                                      ShortUnit representation
                                                                                                                                      Control0..1
                                                                                                                                      Typestring
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      548. Observation.component:accuracyComponent.value[x]:valueQuantity.system
                                                                                                                                      Definition

                                                                                                                                      The unit code shall use the UCUM system

                                                                                                                                      ShortSystem that defines coded unit form
                                                                                                                                      Control1..1
                                                                                                                                      This element is affected by the following invariants: qty-3
                                                                                                                                      Typeuri
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Need to know the system that defines the coded form of the unit.

                                                                                                                                      Fixed Valuehttp://unitsofmeasure.org
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      550. Observation.component:accuracyComponent.value[x]:valueQuantity.code
                                                                                                                                      Definition

                                                                                                                                      The units for the Accuracy are given by the units of the measurement so this entry shall have the same code as in Observation.valueQuantity.code

                                                                                                                                      ShortCoded form of the unit
                                                                                                                                      Comments

                                                                                                                                      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                                                                                                      Control1..1
                                                                                                                                      Typecode
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      552. Observation.component:accuracyComponent.dataAbsentReason
                                                                                                                                      Definition

                                                                                                                                      Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                                                                                                                      ShortWhy the component result is missing
                                                                                                                                      Comments

                                                                                                                                      "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                                                                                                                      The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                                                                                                                      Control0..0
                                                                                                                                      This element is affected by the following invariants: obs-6
                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

                                                                                                                                      Codes specifying why the result (Observation.value[x]) is missing.

                                                                                                                                      TypeCodeableConcept
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Must Supportfalse
                                                                                                                                      Summaryfalse
                                                                                                                                      Requirements

                                                                                                                                      For many results it is necessary to handle exceptional values in measurements.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      554. Observation.component:accuracyComponent.interpretation
                                                                                                                                      Definition

                                                                                                                                      A categorical assessment of an observation value. For example, high, low, normal.

                                                                                                                                      ShortHigh, low, normal, etc.
                                                                                                                                      Comments

                                                                                                                                      Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                                                                      Control0..*
                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                                                                                      Codes identifying interpretations of observations.

                                                                                                                                      TypeCodeableConcept
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Must Supportfalse
                                                                                                                                      Summaryfalse
                                                                                                                                      Requirements

                                                                                                                                      For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                                                                      Alternate NamesAbnormal Flag
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      556. Observation.component:accuracyComponent.referenceRange
                                                                                                                                      Definition

                                                                                                                                      Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                                                                                      ShortProvides guide for interpretation of component result
                                                                                                                                      Comments

                                                                                                                                      Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                                                                      Control0..*
                                                                                                                                      TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Must Supportfalse
                                                                                                                                      Summaryfalse
                                                                                                                                      Requirements

                                                                                                                                      Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))