Consolidated CDA
3.0.0-ballot - ballot United States of America flag

This page is part of the CCDA: Consolidated CDA Release (v3.0.0-ballot: CCDA 3.0 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions

Logical Model: Family History Observation

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/FamilyHistoryObservation Version: 3.0.0-ballot
Draft as of 2023-12-21 Computable Name: FamilyHistoryObservation
Other Identifiers: id: urn:hl7ii:2.16.840.1.113883.10.20.22.4.46:2015-08-01

Family History Observations related to a particular family member are contained within a Family History Organizer. The effectiveTime in the Family History Observation is the biologically or clinically relevant time of the observation. The biologically or clinically relevant time is the time at which the observation holds (is effective) for the family member (the subject of the observation).

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csFixed Value: OBS
... @moodCode 1..1csFixed Value: EVN
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1CS
.... @code 1..1csFixed Value: completed
... effectiveTime 0..1IVL_TS
... value 1..1CDBinding: Problem (required)
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @typeCode 1..1csFixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... observation 1..1AgeObservationBase for all types and resources
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @typeCode 1..1csFixed Value: CAUS
..... observation 1..1FamilyHistoryDeathObservationBase for all types and resources

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.translationpreferredProblemTypeLOINC
Observation.valuerequiredProblem

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csBinding: ActClassObservation (2.0.0) (required)
Fixed Value: OBS
... @moodCode 1..1csBinding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1CSBinding: ActStatus (required)
.... @code 1..1csFixed Value: completed
... effectiveTime 0..1IVL_TS
... value 1..1CDBinding: Problem (required)
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... observation C1..1AgeObservationBase for all types and resources
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: CAUS
..... observation C1..1FamilyHistoryDeathObservationBase for all types and resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.classCoderequiredFixed Value: OBS
Observation.moodCoderequiredFixed Value: EVN
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.translationpreferredProblemTypeLOINC
Observation.statusCoderequiredActStatus
Observation.valuerequiredProblem
Observation.entryRelationship:ageObservation.typeCoderequiredFixed Value: SUBJ
Observation.entryRelationship:deathObservation.typeCoderequiredFixed Value: CAUS

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-text-ref-valuewarningObservation.entryRelationship:ageObservation.observation, Observation.entryRelationship:deathObservation.observationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... @nullFlavor 0..1csBinding: CDANullFlavor (required)
... realmCode 0..*CS
... typeId 0..1II
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1st
.... @displayable 0..1bl
.... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... @assigningAuthorityName 0..1st
..... @displayable 0..1bl
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csBinding: ActClassObservation (2.0.0) (required)
Fixed Value: OBS
... @moodCode 1..1csBinding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... @negationInd 0..1bl
... id 1..*II
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @code 0..1cs
.... @codeSystem 0..1oid, uuid, ruid
.... @codeSystemName 0..1st
.... @codeSystemVersion 0..1st
.... @displayName 0..1st
.... @sdtcValueSet 0..1oidXML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1stXML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
.... originalText 0..1ED
.... qualifier 0..*CR
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... derivationExpr 0..1ST
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @compression 0..1csBinding: CompressionAlgorithm (required)
.... @integrityCheck 0..1bin
.... @integrityCheckAlgorithm 0..1csBinding: IntegrityCheckAlgorithm (2.0.0) (required)
.... @language 0..1cs
.... @mediaType 0..1csBinding: MediaType (example)
.... @representation 0..1csBinding: Binary Data Encoding Value Set (required)
.... xmlText 0..1stAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1ED
... statusCode 1..1CSBinding: ActStatus (required)
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @code 1..1csFixed Value: completed
.... @sdtcValueSet 0..1oidXML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1stXML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 0..1IVL_TS
... priorityCode 0..1CEBinding: ActPriority (example)
... repeatNumber 0..1IVL_INT
... languageCode 0..1CSBinding: AllLanguages (required)
... value 1..1CDBinding: Problem (required)
... interpretationCode 0..*CEBinding: ObservationInterpretation (required)
... methodCode 0..*CEBinding: ObservationMethod (example)
... targetSiteCode 0..*CD
... subject 0..1Subject
... specimen 0..*Specimen
... performer 0..*Performer2
... author 0..*Author
... informant 0..*Informant
... participant 0..*Participant2
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... realmCode 0..*CS
..... typeId 0..1II
...... @nullFlavor 0..1csBinding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1st
...... @displayable 0..1bl
...... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1st
..... templateId 0..*II
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... @contextConductionInd 0..1bl
..... @negationInd 0..1bl
..... sequenceNumber 0..1INT
..... seperatableInd 0..1BL
..... act 0..1Act
..... encounter 0..1Encounter
..... observation C1..1AgeObservationBase for all types and resources
..... observationMedia 0..1ObservationMedia
..... organizer 0..1Organizer
..... procedure 0..1Procedure
..... regionOfInterest 0..1RegionOfInterest
..... substanceAdministration 0..1SubstanceAdministration
..... supply 0..1Supply
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... realmCode 0..*CS
..... typeId 0..1II
...... @nullFlavor 0..1csBinding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1st
...... @displayable 0..1bl
...... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1st
..... templateId 0..*II
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: CAUS
..... @inversionInd 0..1bl
..... @contextConductionInd 0..1bl
..... @negationInd 0..1bl
..... sequenceNumber 0..1INT
..... seperatableInd 0..1BL
..... act 0..1Act
..... encounter 0..1Encounter
..... observation C1..1FamilyHistoryDeathObservationBase for all types and resources
..... observationMedia 0..1ObservationMedia
..... organizer 0..1Organizer
..... procedure 0..1Procedure
..... regionOfInterest 0..1RegionOfInterest
..... substanceAdministration 0..1SubstanceAdministration
..... supply 0..1Supply
... reference 0..*Reference
... precondition 0..*Precondition
... sdtcPrecondition2 0..*Precondition2XML Namespace: urn:hl7-org:sdtc
XML: precondition2 (urn:hl7-org:sdtc)
... referenceRange 0..*InfrastructureRoot
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... realmCode 0..*CS
.... typeId 0..1II
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... @assigningAuthorityName 0..1st
..... @displayable 0..1bl
..... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
..... @extension 1..1st
.... templateId 0..*II
.... @typeCode 0..1csBinding: ActRelationshipType (2.0.0) (required)
Fixed Value: REFV
.... observationRange 1..1ObservationRange
... sdtcInFulfillmentOf1 0..*InFulfillmentOf1XML Namespace: urn:hl7-org:sdtc
XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.nullFlavorrequiredCDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
Observation.templateId:family-history-obs.nullFlavorrequiredCDANullFlavor
Observation.classCoderequiredFixed Value: OBS
Observation.moodCoderequiredFixed Value: EVN
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.nullFlavorrequiredCDANullFlavor
Observation.code.translationpreferredProblemTypeLOINC
Observation.text.nullFlavorrequiredCDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
Observation.text.mediaTypeexampleMediaType
Observation.text.representationrequiredBinaryDataEncoding
Observation.statusCoderequiredActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
Observation.priorityCodeexampleActPriority
Observation.languageCoderequiredAllLanguages
Observation.valuerequiredProblem
Observation.interpretationCoderequiredObservationInterpretation
Observation.methodCodeexampleObservationMethod
Observation.entryRelationship:ageObservation.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:ageObservation.typeId.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:ageObservation.typeCoderequiredFixed Value: SUBJ
Observation.entryRelationship:deathObservation.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:deathObservation.typeId.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:deathObservation.typeCoderequiredFixed Value: CAUS
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-text-ref-valuewarningObservation.entryRelationship:ageObservation.observation, Observation.entryRelationship:deathObservation.observationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')

This structure is derived from Observation

Summary

Mandatory: 9 elements (3 nested mandatory elements)
Fixed Value: 6 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Observation.templateId is sliced based on the values of value:root, value:extension
  • The element Observation.entryRelationship is sliced based on the values of profile:observation, value:typeCode

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csFixed Value: OBS
... @moodCode 1..1csFixed Value: EVN
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1CS
.... @code 1..1csFixed Value: completed
... effectiveTime 0..1IVL_TS
... value 1..1CDBinding: Problem (required)
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @typeCode 1..1csFixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... observation 1..1AgeObservationBase for all types and resources
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @typeCode 1..1csFixed Value: CAUS
..... observation 1..1FamilyHistoryDeathObservationBase for all types and resources

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.translationpreferredProblemTypeLOINC
Observation.valuerequiredProblem

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csBinding: ActClassObservation (2.0.0) (required)
Fixed Value: OBS
... @moodCode 1..1csBinding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1CSBinding: ActStatus (required)
.... @code 1..1csFixed Value: completed
... effectiveTime 0..1IVL_TS
... value 1..1CDBinding: Problem (required)
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... observation C1..1AgeObservationBase for all types and resources
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: CAUS
..... observation C1..1FamilyHistoryDeathObservationBase for all types and resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.classCoderequiredFixed Value: OBS
Observation.moodCoderequiredFixed Value: EVN
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.translationpreferredProblemTypeLOINC
Observation.statusCoderequiredActStatus
Observation.valuerequiredProblem
Observation.entryRelationship:ageObservation.typeCoderequiredFixed Value: SUBJ
Observation.entryRelationship:deathObservation.typeCoderequiredFixed Value: CAUS

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-text-ref-valuewarningObservation.entryRelationship:ageObservation.observation, Observation.entryRelationship:deathObservation.observationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C1..1ObservationXML Namespace: urn:hl7-org:v3
Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instances of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-effectiveTime: SHOULD contain effectiveTime
... @nullFlavor 0..1csBinding: CDANullFlavor (required)
... realmCode 0..*CS
... typeId 0..1II
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1st
.... @displayable 0..1bl
.... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... Slices for templateId 1..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:family-history-obs 1..1II
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... @assigningAuthorityName 0..1st
..... @displayable 0..1bl
..... @root 1..1oid, uuid, ruidRequired Pattern: 2.16.840.1.113883.10.20.22.4.46
..... @extension 1..1stRequired Pattern: 2015-08-01
... @classCode 1..1csBinding: ActClassObservation (2.0.0) (required)
Fixed Value: OBS
... @moodCode 1..1csBinding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... @negationInd 0..1bl
... id 1..*II
... code 1..1CDBinding: Problem Type (SNOMEDCT) (preferred)
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @code 0..1cs
.... @codeSystem 0..1oid, uuid, ruid
.... @codeSystemName 0..1st
.... @codeSystemVersion 0..1st
.... @displayName 0..1st
.... @sdtcValueSet 0..1oidXML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1stXML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
.... originalText 0..1ED
.... qualifier 0..*CR
.... translation 1..*CDBinding: Problem Type (LOINC) (preferred)
... derivationExpr 0..1ST
... text 0..1EDSHOULD reference the portion of section narrative text corresponding to this entry
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @compression 0..1csBinding: CompressionAlgorithm (required)
.... @integrityCheck 0..1bin
.... @integrityCheckAlgorithm 0..1csBinding: IntegrityCheckAlgorithm (2.0.0) (required)
.... @language 0..1cs
.... @mediaType 0..1csBinding: MediaType (example)
.... @representation 0..1csBinding: Binary Data Encoding Value Set (required)
.... xmlText 0..1stAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
.... reference C0..1TELvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1ED
... statusCode 1..1CSBinding: ActStatus (required)
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... @code 1..1csFixed Value: completed
.... @sdtcValueSet 0..1oidXML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1stXML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 0..1IVL_TS
... priorityCode 0..1CEBinding: ActPriority (example)
... repeatNumber 0..1IVL_INT
... languageCode 0..1CSBinding: AllLanguages (required)
... value 1..1CDBinding: Problem (required)
... interpretationCode 0..*CEBinding: ObservationInterpretation (required)
... methodCode 0..*CEBinding: ObservationMethod (example)
... targetSiteCode 0..*CD
... subject 0..1Subject
... specimen 0..*Specimen
... performer 0..*Performer2
... author 0..*Author
... informant 0..*Informant
... participant 0..*Participant2
... Slices for entryRelationship 0..*EntryRelationshipSlice: Unordered, Open by profile:observation, value:typeCode
.... entryRelationship:ageObservation 0..1EntryRelationship
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... realmCode 0..*CS
..... typeId 0..1II
...... @nullFlavor 0..1csBinding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1st
...... @displayable 0..1bl
...... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1st
..... templateId 0..*II
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: SUBJ
..... @inversionInd 1..1blFixed Value: true
..... @contextConductionInd 0..1bl
..... @negationInd 0..1bl
..... sequenceNumber 0..1INT
..... seperatableInd 0..1BL
..... act 0..1Act
..... encounter 0..1Encounter
..... observation C1..1AgeObservationBase for all types and resources
..... observationMedia 0..1ObservationMedia
..... organizer 0..1Organizer
..... procedure 0..1Procedure
..... regionOfInterest 0..1RegionOfInterest
..... substanceAdministration 0..1SubstanceAdministration
..... supply 0..1Supply
.... entryRelationship:deathObservation 0..1EntryRelationship
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... realmCode 0..*CS
..... typeId 0..1II
...... @nullFlavor 0..1csBinding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1st
...... @displayable 0..1bl
...... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1st
..... templateId 0..*II
..... @typeCode 1..1csBinding: x_ActRelationshipEntryRelationship (required)
Fixed Value: CAUS
..... @inversionInd 0..1bl
..... @contextConductionInd 0..1bl
..... @negationInd 0..1bl
..... sequenceNumber 0..1INT
..... seperatableInd 0..1BL
..... act 0..1Act
..... encounter 0..1Encounter
..... observation C1..1FamilyHistoryDeathObservationBase for all types and resources
..... observationMedia 0..1ObservationMedia
..... organizer 0..1Organizer
..... procedure 0..1Procedure
..... regionOfInterest 0..1RegionOfInterest
..... substanceAdministration 0..1SubstanceAdministration
..... supply 0..1Supply
... reference 0..*Reference
... precondition 0..*Precondition
... sdtcPrecondition2 0..*Precondition2XML Namespace: urn:hl7-org:sdtc
XML: precondition2 (urn:hl7-org:sdtc)
... referenceRange 0..*InfrastructureRoot
.... @nullFlavor 0..1csBinding: CDANullFlavor (required)
.... realmCode 0..*CS
.... typeId 0..1II
..... @nullFlavor 0..1csBinding: CDANullFlavor (required)
..... @assigningAuthorityName 0..1st
..... @displayable 0..1bl
..... @root 1..1oid, uuid, ruidFixed Value: 2.16.840.1.113883.1.3
..... @extension 1..1st
.... templateId 0..*II
.... @typeCode 0..1csBinding: ActRelationshipType (2.0.0) (required)
Fixed Value: REFV
.... observationRange 1..1ObservationRange
... sdtcInFulfillmentOf1 0..*InFulfillmentOf1XML Namespace: urn:hl7-org:sdtc
XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.nullFlavorrequiredCDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
Observation.templateId:family-history-obs.nullFlavorrequiredCDANullFlavor
Observation.classCoderequiredFixed Value: OBS
Observation.moodCoderequiredFixed Value: EVN
Observation.codepreferredProblemTypeSNOMEDCT
Observation.code.nullFlavorrequiredCDANullFlavor
Observation.code.translationpreferredProblemTypeLOINC
Observation.text.nullFlavorrequiredCDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
Observation.text.mediaTypeexampleMediaType
Observation.text.representationrequiredBinaryDataEncoding
Observation.statusCoderequiredActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
Observation.priorityCodeexampleActPriority
Observation.languageCoderequiredAllLanguages
Observation.valuerequiredProblem
Observation.interpretationCoderequiredObservationInterpretation
Observation.methodCodeexampleObservationMethod
Observation.entryRelationship:ageObservation.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:ageObservation.typeId.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:ageObservation.typeCoderequiredFixed Value: SUBJ
Observation.entryRelationship:deathObservation.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:deathObservation.typeId.nullFlavorrequiredCDANullFlavor
Observation.entryRelationship:deathObservation.typeCoderequiredFixed Value: CAUS
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV

Constraints

IdGradePath(s)DetailsRequirements
should-effectiveTimewarningObservationSHOULD contain effectiveTime
: effectiveTime.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-text-ref-valuewarningObservation.entryRelationship:ageObservation.observation, Observation.entryRelationship:deathObservation.observationSHOULD contain text/reference/@value
: text.reference.value.exists()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')

This structure is derived from Observation

Summary

Mandatory: 9 elements (3 nested mandatory elements)
Fixed Value: 6 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Observation.templateId is sliced based on the values of value:root, value:extension
  • The element Observation.entryRelationship is sliced based on the values of profile:observation, value:typeCode

 

Other representations of profile: CSV, Excel