SDOH Clinical Care
3.0.0-ballot - STU 3 Ballot

SDOH Clinical Care - Downloaded Version 3.0.0-ballot See the Directory of published versions

## Resource Profile: SDOHCC Observation Assessment

Official URL: http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationAssessment | Version: 3.0.0-ballot
Standards status: Trial-use Active as of 2025-12-13 | Maturity Level: 2 | Computable Name: SDOHCCObservationAssessment

Profile for Social Determinants of Health (SDOH) observations that involve assessment (e.g., by a provider, payer, etc.) as opposed to being derived only from screening surveys (as is the case for the SDOHCC Screening Response Observation).

### Purpose

SDOHCC Observation Assessment is intended for social risk-related Observations that involve an assessment (e.g., by a provider, payer, etc.) rather than being derived only from question-answer pairs on assessment instruments (as is the case for SDOHCC Observation Screening Response).

### Usage

The `Observation.category` slice with binding to SDOHCC ValueSet SDOH Category allows categorization of the Observation into an SDOH category (domain). However, unlike SDOHCC Observation Screening Response, this profile does not have Gravity-vetted, preferred value sets in VSAC. This was intentional so as not to constrain the social risk observations that a provider might make about an individual.

Of note, Gravity Project is continuously developing terminology for new SDOH domains, and some SDOH domains may not yet be represented in SDOHCC ValueSet SDOH Category. In this case, `Observation.category`: sdoh-category-unspecified can be used and `Observation.category.text` can be added to further specify the domain. For example, at the time of publication of this IG, “disability-status” is not yet included in SDOHCC ValueSet SDOH Category. In this case, `Observation.category`: sdoh-category-unspecified can be used along with `Observation.category.text`: Disability Status.

Usages:

- Refer to this Profile: SDOHCC Condition, SDOHCC Goal, SDOHCC Procedure, SDOHCC ServiceRequest and SDOHCC Task For Referral Management
- Examples for this Profile: Observation/SDOHCC-ObservationAssessmentInadequateFoodIntakeExample and Observation/SDOHCC-ObservationAssessmentTransportTooExpensiveExample
- CapabilityStatements using this Profile: SDOHCC Coordination Platform, SDOHCC Patient Application, SDOHCC Referral Recipient, SDOHCC Referral Recipient - Light and SDOHCC Referral Source

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: obs-6, obs-7, us-core-2, SDOH-Obs-4
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S C | 1..* | CodeableConcept | Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code | S Σ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | Who and/or what the observation is about
effective[x] | S Σ | 0..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer | S Σ | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Actual result
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
derivedFrom | Σ | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📍7.0.0 | US Core v7.0
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: us-core-2, SDOH-Obs-4
Slices for category |  |  |  | Content/Rules for all slices
category:us-core | C | 1..* | CodeableConcept | Requires at least a category code 'sdoh'
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code |  | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject |  | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | Who and/or what the observation is about
effective[x] |  | 0..1 | dateTime, Period, Timing, instant | Clinically relevant time/time-period for observation
performer |  | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
derivedFrom |  | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: obs-6, obs-7, us-core-2, SDOH-Obs-4
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S C | 1..* | CodeableConcept | Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code | S Σ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | 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] | S Σ | 0..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Actual result
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 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 Constraints: obs-3
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(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
component | Σ | 0..* | BackboneElement | Component results
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 | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x] | Σ | 0..1 |  | Actual component result
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📍7.0.0 | US Core v7.0
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📦4.0.1 | FHIR Std.
Observation.component.​code | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|7.0.0)
- SDOHCC PractitionerRole (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam|7.0.0)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|7.0.0)
- US Core QuestionnaireResponse Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|7.0.0)

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: obs-6, obs-7, us-core-2, SDOH-Obs-4
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S C | 1..* | CodeableConcept | Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code | S Σ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | Who and/or what the observation is about
effective[x] | S Σ | 0..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer | S Σ | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Actual result
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
derivedFrom | Σ | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📍7.0.0 | US Core v7.0
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: us-core-2, SDOH-Obs-4
Slices for category |  |  |  | Content/Rules for all slices
category:us-core | C | 1..* | CodeableConcept | Requires at least a category code 'sdoh'
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code |  | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject |  | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | Who and/or what the observation is about
effective[x] |  | 0..1 | dateTime, Period, Timing, instant | Clinically relevant time/time-period for observation
performer |  | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
derivedFrom |  | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(7.0.0) | SDOH assessment observation Constraints: obs-6, obs-7, us-core-2, SDOH-Obs-4
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S C | 1..* | CodeableConcept | Requires at least a category code 'sdoh' Binding: USCoreSimpleObservationCategory (7.0.0) (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:SDOHCC | S | 0..* | CodeableConcept | e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code | S Σ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0) | Group) | 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] | S Σ | 0..1 |  | Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core RelatedPerson Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core Practitioner Profile(7.0.0) | SDOHCC PractitionerRole | US Core Organization Profile(7.0.0) | US Core CareTeam Profile(7.0.0)) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Actual result
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 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 Constraints: obs-3
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(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(Observation | US Core DocumentReference Profile(7.0.0) | US Core QuestionnaireResponse Profile(7.0.0) | ImagingStudy | Media | MolecularSequence) | ADDITIONAL USCDI: US Core Profiles or other resource the observation is made from
component | Σ | 0..* | BackboneElement | Component results
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 | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x] | Σ | 0..1 |  | Actual component result
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📍7.0.0 | US Core v7.0
Observation.category:SDOHCC | Base | required | SDOHCC ValueSet SDOH Category | 📦3.0.0-ballot | This IG
Observation.code | Base | preferred | SDOHCC ValueSet LOINC SNOMEDCT | 📦3.0.0-ballot | This IG
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📦4.0.1 | FHIR Std.
Observation.component.​code | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
SDOH-Obs-4 | error | Observation | At least one Observation.category SHALL be sdoh | `category.where(coding.where(system = 'http://hl7.org/fhir/us/core/CodeSystem/us-core-category' and code='sdoh').exists()).exists()`
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
us-core-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|7.0.0)
- SDOHCC PractitionerRole (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam|7.0.0)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|7.0.0)
- US Core QuestionnaireResponse Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|7.0.0)

Maturity: 2

Other representations of profile: CSV, Excel, Schematron