Summary

"#### Complete Summary of the Mandatory Requirements

1. One status in Observation.statuswhich has a required binding to:

   • ObservationStatus value set.

2. A category in Observation.category which must have:

   • a fixed Observation.category.coding.system="http://terminology.hl7.org/CodeSystem/observation-category"
   • a fixed Observation.category.coding.code= "vital-signs"

3. A code in Observation.code

   • a fixed Observation.code.coding.system= "http://loinc.org""
   • a LOINC code in Observation.code.coding.code which has an extensible binding to:
     • Vital Signs value set.

4. One patient in Observation.subject

5. A date and time in effectiveDateTime or effectivePeriod

6. Either one Observation.value[x] or, if there is no value, one code in Observation.DataAbsentReason

   • if a vital sign measure then:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code which has an required binding to the Vital Signs Units value set.
   • Observation.DataAbsentReason is bound to Observation Value Absent Reason value set.

7. When using a panel code to group component observations (Note: See the comments regarding blood pressure in the table above), one or more Observation.component.code each of which must have:

   • a fixed Observation.component.code.coding.system =""http://loinc.org""
     • a LOINC code in Observation.code.coding.code which has an extensible binding to:
       • Vital Signs Units value set.

8. Either one Observation.component.valueQuantity or, if there is no value, one code in Observation.component.DataAbsentReason

   • Observation.component.DataAbsentReason is bound to Observation Value Absent Reason value set.

9. When using a panel code to group observations, one or more reference to Vitals Signs Observations in Observation.related.target

   • a fixed Observation.related.type= "has-member""

Mandatory: 9 elements (+1 nested mandatory element)
Must-Support: 15 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the values of value:coding.code, value:coding.system

<!-- observation-vitalsigns -->

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!--  0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!--  0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!--  0..1 Language of the resource content   -->
 <text><!--  0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!--  0..* Identifier 
     Business Identifier for observation --></identifier>
 <basedOn><!--  0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <partOf><!--  0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!--  1..1 registered | preliminary | final | amended +   -->
 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <category>  1..1 CodeableConcept  <!--  1..1 Classification of  type of observation -->
  <coding>  1..* Coding  <!--  1..* Code defined by a terminology system -->
   <system value="[uri]"/><!--  1..1 Identity of the terminology system -->
   <version value="[string]"/><!--  0..1 Version of the system - if relevant -->
   <code value="[code]"/><!--  1..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!--  0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!--  0..1 If this coding was chosen directly by the user -->
  </coding>
  <text value="[string]"/><!--  0..1 Plain text representation of the concept -->
 </category>
 <code><!--  1..1 CodeableConcept Coded Responses from C-CDA Vital Sign Results   --></code>
 <subject><!--  1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!--  0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!--  0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <effective[x]><!--  1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!--  0..1 Date/Time this version was made available -->
 <performer><!--  0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <value[x]><!--  0..1 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period 
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. --></value[x]>
 <dataAbsentReason><!--  0..1 CodeableConcept Why the result is missing   --></dataAbsentReason>
 <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
 <note><!--  0..* Annotation Comments about the observation --></note>
 <bodySite><!--  0..1 CodeableConcept Observed body part   --></bodySite>
 <method><!--  0..1 CodeableConcept How it was done   --></method>
 <specimen><!--  0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!--  0..1 Reference(Device) (Measurement) Device --></device>
 <referenceRange>  0..* BackboneElement  <!--  0..* Provides guide for interpretation -->
  <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <low><!--  0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!--  0..1 Quantity 
      High Range, if relevant --></high>
  <type><!--  0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!--  0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!--  0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[string]"/><!--  0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!--  0..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!--  0..* Reference(DocumentReference) 
     Related measurements the observation is made from --></derivedFrom>
 <component>  0..* BackboneElement  <!--  0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!--  1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <value[x]><!--  0..1 Quantity|CodeableConcept|string|
    boolean|integer|Range|Ratio|SampledData|time|dateTime|Period Vital Sign Value recorded with UCUM   --></value[x]>
  <dataAbsentReason><!--  0..1 CodeableConcept Why the component result is missing   --></dataAbsentReason>
  <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

{ // observation-vitalsigns
  // from Element: extension
    "meta" : { Meta }, // C?Metadata about the resource
    "implicitRules" : "<uri>", // C?A set of rules under which this content was created
    "language" : "<code>", // C?Language of the resource content
    "text" : { Narrative }, // C?Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // C?Extensions that cannot be ignored
    "identifier" : [{ Identifier }], // C?Business Identifier for observation
    "basedOn" : [{ Reference(CarePlan) }], // C?Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], // C?Part of referenced event
    "status" : "<code>", // C? R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // C? R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // C? R! Code defined by a terminology system
        "text" : "<string>" // C?Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // C? R! Coded Responses from C-CDA Vital Sign Results
    "subject" : { Reference(Patient) }, // C? R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // C?What the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // C?Healthcare event during which this observation is made
// value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // C? R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // C? R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // C?Date/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // C?Who is responsible for the observation
// value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 11:
    "valueQuantity" : { Quantity }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueCodeableConcept" : { CodeableConcept }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueString" : "<string>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueBoolean" : <boolean>, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueInteger" : <integer>, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRange" : { Range }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRatio" : { Ratio }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueSampledData" : { SampledData }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueTime" : "<time>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueDateTime" : "<dateTime>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valuePeriod" : { Period }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "dataAbsentReason" : { CodeableConcept } // C?Why the result is missing
    "interpretation" : [{ CodeableConcept }], // C?High, low, normal, etc.
    "note" : [{ Annotation }], // C?Comments about the observation
    "bodySite" : { CodeableConcept }, // C?Observed body part
    "method" : { CodeableConcept }, // C?How it was done
    "specimen" : { Reference(Specimen) }, // C?Specimen used for this observation
    "device" : { Reference(Device) }, // C?(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // C?Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // C?Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }

Summary

"#### Complete Summary of the Mandatory Requirements

1. One status in Observation.statuswhich has a required binding to:

   • ObservationStatus value set.

2. A category in Observation.category which must have:

   • a fixed Observation.category.coding.system="http://terminology.hl7.org/CodeSystem/observation-category"
   • a fixed Observation.category.coding.code= "vital-signs"

3. A code in Observation.code

   • a fixed Observation.code.coding.system= "http://loinc.org""
   • a LOINC code in Observation.code.coding.code which has an extensible binding to:
     • Vital Signs value set.

4. One patient in Observation.subject

5. A date and time in effectiveDateTime or effectivePeriod

6. Either one Observation.value[x] or, if there is no value, one code in Observation.DataAbsentReason

   • if a vital sign measure then:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code which has an required binding to the Vital Signs Units value set.
   • Observation.DataAbsentReason is bound to Observation Value Absent Reason value set.

7. When using a panel code to group component observations (Note: See the comments regarding blood pressure in the table above), one or more Observation.component.code each of which must have:

   • a fixed Observation.component.code.coding.system =""http://loinc.org""
     • a LOINC code in Observation.code.coding.code which has an extensible binding to:
       • Vital Signs Units value set.

8. Either one Observation.component.valueQuantity or, if there is no value, one code in Observation.component.DataAbsentReason

   • Observation.component.DataAbsentReason is bound to Observation Value Absent Reason value set.

9. When using a panel code to group observations, one or more reference to Vitals Signs Observations in Observation.related.target

   • a fixed Observation.related.type= "has-member""

Mandatory: 9 elements (+1 nested mandatory element)
Must-Support: 15 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the values of value:coding.code, value:coding.system

<!-- observation-vitalsigns -->

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!--  0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!--  0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!--  0..1 Language of the resource content   -->
 <text><!--  0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!--  0..* Identifier 
     Business Identifier for observation --></identifier>
 <basedOn><!--  0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <partOf><!--  0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!--  1..1 registered | preliminary | final | amended +   -->
 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <category>  1..1 CodeableConcept  <!--  1..1 Classification of  type of observation -->
  <coding>  1..* Coding  <!--  1..* Code defined by a terminology system -->
   <system value="[uri]"/><!--  1..1 Identity of the terminology system -->
   <version value="[string]"/><!--  0..1 Version of the system - if relevant -->
   <code value="[code]"/><!--  1..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!--  0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!--  0..1 If this coding was chosen directly by the user -->
  </coding>
  <text value="[string]"/><!--  0..1 Plain text representation of the concept -->
 </category>
 <code><!--  1..1 CodeableConcept Coded Responses from C-CDA Vital Sign Results   --></code>
 <subject><!--  1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!--  0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!--  0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <effective[x]><!--  1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!--  0..1 Date/Time this version was made available -->
 <performer><!--  0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <value[x]><!--  0..1 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period 
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. --></value[x]>
 <dataAbsentReason><!--  0..1 CodeableConcept Why the result is missing   --></dataAbsentReason>
 <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
 <note><!--  0..* Annotation Comments about the observation --></note>
 <bodySite><!--  0..1 CodeableConcept Observed body part   --></bodySite>
 <method><!--  0..1 CodeableConcept How it was done   --></method>
 <specimen><!--  0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!--  0..1 Reference(Device) (Measurement) Device --></device>
 <referenceRange>  0..* BackboneElement  <!--  0..* Provides guide for interpretation -->
  <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <low><!--  0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!--  0..1 Quantity 
      High Range, if relevant --></high>
  <type><!--  0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!--  0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!--  0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[string]"/><!--  0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!--  0..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!--  0..* Reference(DocumentReference) 
     Related measurements the observation is made from --></derivedFrom>
 <component>  0..* BackboneElement  <!--  0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!--  0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!--  1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <value[x]><!--  0..1 Quantity|CodeableConcept|string|
    boolean|integer|Range|Ratio|SampledData|time|dateTime|Period Vital Sign Value recorded with UCUM   --></value[x]>
  <dataAbsentReason><!--  0..1 CodeableConcept Why the component result is missing   --></dataAbsentReason>
  <interpretation><!--  0..* CodeableConcept High, low, normal, etc.   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result --></referenceRange>
 </component>
</Observation>

{ // observation-vitalsigns
  // from Element: extension
    "meta" : { Meta }, // C?Metadata about the resource
    "implicitRules" : "<uri>", // C?A set of rules under which this content was created
    "language" : "<code>", // C?Language of the resource content
    "text" : { Narrative }, // C?Text summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // C?Extensions that cannot be ignored
    "identifier" : [{ Identifier }], // C?Business Identifier for observation
    "basedOn" : [{ Reference(CarePlan) }], // C?Fulfills plan, proposal or order
    "partOf" : [{ Reference(MedicationAdministration) }], // C?Part of referenced event
    "status" : "<code>", // C? R! registered | preliminary | final | amended +
    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { // Classification of  type of observation // C? R! 
        // from Element: extension
        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // C? R! Code defined by a terminology system
        "text" : "<string>" // C?Plain text representation of the concept
      }
    ],
    "code" : { CodeableConcept }, // C? R! Coded Responses from C-CDA Vital Sign Results
    "subject" : { Reference(Patient) }, // C? R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // C?What the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // C?Healthcare event during which this observation is made
// value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // C? R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // C? R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // C?Date/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // C?Who is responsible for the observation
// value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 11:
    "valueQuantity" : { Quantity }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueCodeableConcept" : { CodeableConcept }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueString" : "<string>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueBoolean" : <boolean>, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueInteger" : <integer>, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRange" : { Range }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRatio" : { Ratio }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueSampledData" : { SampledData }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueTime" : "<time>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueDateTime" : "<dateTime>", // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valuePeriod" : { Period }, // C?Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "dataAbsentReason" : { CodeableConcept } // C?Why the result is missing
    "interpretation" : [{ CodeableConcept }], // C?High, low, normal, etc.
    "note" : [{ Annotation }], // C?Comments about the observation
    "bodySite" : { CodeableConcept }, // C?Observed body part
    "method" : { CodeableConcept }, // C?How it was done
    "specimen" : { Reference(Specimen) }, // C?Specimen used for this observation
    "device" : { Reference(Device) }, // C?(Measurement) Device
    "referenceRange" : [{ BackboneElement }], // C?Provides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // C?Used when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // C?Related measurements the observation is made from
    "component" : [{ BackboneElement }], // C?Used when reporting systolic and diastolic blood pressure.
  }