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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON

Logical Model: Social History Observation

This template represents a patient’s job (occupation and industry), lifestyle, and environmental health risk factors. Demographic data (e.g., marital status, race, ethnicity, religious affiliation) are captured in the header. Though tobacco use and exposure may be represented with a Social History Observation, it is recommended to use the Current Smoking Status template or the Tobacco Use template instead, to represent smoking or tobacco habits. There are supplemental templates and guidance for observations of Occupational Data for Health, nutrition and pregnancy that could be captured in the Social History Observation, and implementers may want to consider using those more specific templates in the Social History section.

Usage:

• Derived from this Logical Model: Basic Industry Observation, Basic Occupation Observation, Gender Identity Observation, Sexual Orientation Observation and Tribal Affiliation Observation
• Use this Logical Model: Health Concern Act, Risk Concern Act and Social History Section

Formal Views of Profile Content

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

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

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Fixed Value: OBS
@moodCode		1..1	cs	Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS
value		0..1	ANY, BL, ED, ST, CD, CV, CE, CO, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Fixed Value: SPRT
observation		1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Fixed Value: SPRT
act		1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	preferred	SocialHistoryType
Observation.value	example

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS
value		0..1		NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
value			ANY
value			BL
value			ED
value			ST
value			CD
value			CV
value			CE
value			CO
value			SC
value			II
value			TEL
value			AD
value			EN
value			INT
value			REAL
value			PQ
value			MO
value			TS
value			IVL_PQ
value			IVL_TS
value			PIVL_TS
value			EIVL_TS
value			SXPR_TS
value			RTO_PQ_PQ
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.statusCode	required	ActStatus
Observation.value	example
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime		1..1	IVL_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		0..1		NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
value			ANY
value			BL
value			ED
value			ST
value			CD
value			CV
value			CE
value			CO
value			SC
value			II
value			TEL
value			AD
value			EN
value			INT
value			REAL
value			PQ
value			MO
value			TS
value			IVL_PQ
value			IVL_TS
value			PIVL_TS
value			EIVL_TS
value			SXPR_TS
value			RTO_PQ_PQ
interpretationCode		0..*	CE	Binding: ObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: ActRelationshipType (2.0.0) (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.nullFlavor	required	CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor
Observation.templateId:social-history-obs.nullFlavor	required	CDANullFlavor
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.text.nullFlavor	required	CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Observation.text.mediaType	example	MediaType
Observation.text.representation	required	BinaryDataEncoding
Observation.statusCode	required	ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor
Observation.priorityCode	example	ActPriority
Observation.languageCode	required	AllLanguages
Observation.value	example
Observation.interpretationCode	required	ObservationInterpretation
Observation.methodCode	example	ObservationMethod
Observation.entryRelationship:social-history-entry-sprt-obs.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT
Observation.referenceRange.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If 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: 8 elements (2 nested mandatory elements)
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• Assessment Scale Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AssessmentScaleObservation)
• Entry Reference (http://hl7.org/cda/us/ccda/StructureDefinition/EntryReference)

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:act, profile:observation

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Fixed Value: OBS
@moodCode		1..1	cs	Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS
value		0..1	ANY, BL, ED, ST, CD, CV, CE, CO, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Fixed Value: SPRT
observation		1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Fixed Value: SPRT
act		1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	preferred	SocialHistoryType
Observation.value	example

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS
value		0..1		NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
value			ANY
value			BL
value			ED
value			ST
value			CD
value			CV
value			CE
value			CO
value			SC
value			II
value			TEL
value			AD
value			EN
value			INT
value			REAL
value			PQ
value			MO
value			TS
value			IVL_PQ
value			IVL_TS
value			PIVL_TS
value			EIVL_TS
value			SXPR_TS
value			RTO_PQ_PQ
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.statusCode	required	ActStatus
Observation.value	example
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML 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-value: SHOULD contain value 4515-8555: If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. should-sh-author: SHOULD contain author
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred) 4515-32956: If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956).
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime		1..1	IVL_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		0..1		NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: (unbound) (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
value			ANY
value			BL
value			ED
value			ST
value			CD
value			CV
value			CE
value			CO
value			SC
value			II
value			TEL
value			AD
value			EN
value			INT
value			REAL
value			PQ
value			MO
value			TS
value			IVL_PQ
value			IVL_TS
value			PIVL_TS
value			EIVL_TS
value			SXPR_TS
value			RTO_PQ_PQ
interpretationCode		0..*	CE	Binding: ObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: ActRelationshipType (2.0.0) (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.nullFlavor	required	CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor
Observation.templateId:social-history-obs.nullFlavor	required	CDANullFlavor
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.text.nullFlavor	required	CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Observation.text.mediaType	example	MediaType
Observation.text.representation	required	BinaryDataEncoding
Observation.statusCode	required	ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor
Observation.priorityCode	example	ActPriority
Observation.languageCode	required	AllLanguages
Observation.value	example
Observation.interpretationCode	required	ObservationInterpretation
Observation.methodCode	example	ObservationMethod
Observation.entryRelationship:social-history-entry-sprt-obs.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT
Observation.referenceRange.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If 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: 8 elements (2 nested mandatory elements)
Fixed Value: 5 elements

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• Assessment Scale Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AssessmentScaleObservation)
• Entry Reference (http://hl7.org/cda/us/ccda/StructureDefinition/EntryReference)

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:act, profile:observation

Other representations of profile: CSV, Excel