US Core Implementation Guide
8.0.0-ballot - STU8 Ballot United States of America flag

This page is part of the US Core (v8.0.0-ballot: STU8 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core Vital Signs Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreVitalSignsProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.67

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile is based on the base FHIR Vital Signs Profile and defines additional constraints on the Observation resource to represent vital signs observations. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. This US Core profiles that are derived from this profile are listed below.

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile-specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. The "Snapshot Table (Must Support)" tab below displays all the Mandatory and Must Support data elements for this profile and those inherited from the US Core Vital Signs Profile.

Each Observation Must Have:

  1. a status
  2. a category code of "vital-signs"
  3. a LOINC code, if available, which tells you what is being measured
  4. a patient
  5. a clinically relevant time

Each Observation Must Support:

  1. a performer*
  2. a result value
    • if the result value is a numeric quantity, a standard UCUM unit
  3. a reason if the value is absent*
  4. component results

*see guidance below

Profile Specific Implementation Guidance:

  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local system-specific code
    • providing more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.

    A code system value SHOULD be supplied for each additional code.

  • The observations MAY have component observations. For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.
  • *An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.
    • For further guidance, see the Observation Grouping section in FHIR Specification.
    • Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
  • *An Observation.component without a value, SHALL include a reason why the data is absent.
    • Systems that never provide a component observation without a component value are not required to support Observation.component.dataAbsentReason.
  • Implementers may use this profile as a base for other vital signs in addition to those in this guide.
  • *The profile elements Observation.performer and Observation.device communicate the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

This profile conforms to the base FHIR ver 4.0.1 vitals profile, which defines a required binding for Quantity.code concepts. This means validation errors occur when validating derived profiles that use other Quantity.code concepts such as L/min for Observation.component.value(x) in the US Core Pulse Oximetry Profile. This known issue has been corrected in the base FHIR specification since version 4.3.0 ("Release 4B").

Usage:

Changes since version 7.0.0:

  • The data elements list has changed

    • Formal Views of Profile Content

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

    This structure is derived from observation-vitalsigns

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* observation-vitalsigns US Core Vital Signs Profile
    ... status S 1..1 code registered | preliminary | final | amended +
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    ..... coding S 1..* Coding Code defined by a terminology system
    ...... system S 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code S 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ... code S 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    ... subject S 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... effective[x] S 1..1 Often just a dateTime for Vital Signs
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... performer S 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... value[x] S 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason S 0..1 CodeableConcept Why the result is missing
    ... component S 0..* BackboneElement Component observations
    .... code S 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] S 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason S 0..1 CodeableConcept Why the component result is missing

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* observation-vitalsigns US Core Vital Signs Profile
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ele-1: All FHIR elements must have a @value or children
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ele-1: All FHIR elements must have a @value or children
    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ele-1: All FHIR elements must have a @value or children
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ele-1: All FHIR elements must have a @value or children
    ...... system SΣ 1..1 uri Identity of the terminology system
    ele-1: All FHIR elements must have a @value or children
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    ele-1: All FHIR elements must have a @value or children
    Fixed Value: vital-signs
    ... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    ele-1: All FHIR elements must have a @value or children
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ele-1: All FHIR elements must have a @value or children
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    ele-1: All FHIR elements must have a @value or children
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ele-1: All FHIR elements must have a @value or children
    ... value[x] SΣC 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.


    ele-1: All FHIR elements must have a @value or children
    .... valueQuantity Quantity
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    ele-1: All FHIR elements must have a @value or children
    ... component SΣC 0..* BackboneElement Component observations
    ele-1: All FHIR elements must have a @value or children
    vs-3: If there is no a value a data absent reason must be present
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    ele-1: All FHIR elements must have a @value or children
    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.


    ele-1: All FHIR elements must have a @value or children
    ..... valueQuantity Quantity
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* observation-vitalsigns US Core Vital Signs Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... version Σ 0..1 string Version of the system - if relevant
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ...... display Σ 0..1 string Representation defined by the system
    ...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
    ..... text Σ 0..1 string Plain text representation of the concept
    ... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... value[x] SΣC 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Observed body part
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Observation.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

    Differential View

    This structure is derived from observation-vitalsigns

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* observation-vitalsigns US Core Vital Signs Profile
    ... status S 1..1 code registered | preliminary | final | amended +
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    ..... coding S 1..* Coding Code defined by a terminology system
    ...... system S 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code S 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ... code S 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    ... subject S 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... effective[x] S 1..1 Often just a dateTime for Vital Signs
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... performer S 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... value[x] S 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason S 0..1 CodeableConcept Why the result is missing
    ... component S 0..* BackboneElement Component observations
    .... code S 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] S 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason S 0..1 CodeableConcept Why the component result is missing

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* observation-vitalsigns US Core Vital Signs Profile
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ele-1: All FHIR elements must have a @value or children
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ele-1: All FHIR elements must have a @value or children
    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ele-1: All FHIR elements must have a @value or children
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ele-1: All FHIR elements must have a @value or children
    ...... system SΣ 1..1 uri Identity of the terminology system
    ele-1: All FHIR elements must have a @value or children
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    ele-1: All FHIR elements must have a @value or children
    Fixed Value: vital-signs
    ... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    ele-1: All FHIR elements must have a @value or children
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ele-1: All FHIR elements must have a @value or children
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    ele-1: All FHIR elements must have a @value or children
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ele-1: All FHIR elements must have a @value or children
    ... value[x] SΣC 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.


    ele-1: All FHIR elements must have a @value or children
    .... valueQuantity Quantity
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    ele-1: All FHIR elements must have a @value or children
    ... component SΣC 0..* BackboneElement Component observations
    ele-1: All FHIR elements must have a @value or children
    vs-3: If there is no a value a data absent reason must be present
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    ele-1: All FHIR elements must have a @value or children
    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.


    ele-1: All FHIR elements must have a @value or children
    ..... valueQuantity Quantity
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* observation-vitalsigns US Core Vital Signs Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... version Σ 0..1 string Version of the system - if relevant
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ...... display Σ 0..1 string Representation defined by the system
    ...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
    ..... text Σ 0..1 string Plain text representation of the concept
    ... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... value[x] SΣC 0..1 Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Observed body part
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Observation.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to vital signs data SHALL support these US Core SMART Scopes:

    • resource level scopes: <patient|user|system>/Observation.rs

    • granular scopes: <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the combination of the patient and category search parameters:

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = vital-signs (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and code search parameters:
      • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)

    3. SHALL support searching using the combination of the patient and category and date search parameters:
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = vital-signs (how to search by reference and how to search by token and how to search by date)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and category and status search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and category and _lastUpdated search parameters:
      • including support for these _lastUpdated comparators: gt,lt,ge,le
      • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)

    3. SHOULD support searching using the combination of the patient and code and date search parameters:
      • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)