StructureDefinition: BMI Observationbmi - XML

BMI Observationbmi

<?xml version="1.0" encoding="UTF-8"?>


This element is labelled as a modifier because the implicit rules may provide additional
       knowledge about the resource that modifies it's meaning or interpretation.
      
      
      
        
        
        
      
      
        
      
      
      
    
    
      
      
      
      Language is provided to support indexing and accessibility (typically, services such as
       text to speech use the language tag). The html language tag in the narrative applies 
       to the narrative. The language tag on the resource may be used to specify the language
       of other presentations generated from the data in the resource  Not all the content has
       to be in the base language. The Resource.language should not be assumed to apply to the
       narrative automatically. If a language is specified, it should it also be specified on
       the div element in the html (see rules in HTML5 for information about the relationship
       between xml:lang and the html lang attribute).
      
      
      
        
        
        
      
      
        
      
      
        
          
            
          
        
        
          
        
        
          
        
        
        
        
          
        
      
    
    
      
      
      A human-readable narrative that contains a summary of the resource, and may be used to
       represent the content of the resource to a human. The narrative need not encode all the
       structured data, but is required to contain sufficient detail to make it &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety.
      Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative. In some cases, a resource may only have text with little or no additional
       discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary
       for data from legacy systems where information is captured as a &quot;text blob&quot;
       or where text is additionally entered raw or narrated and encoded in formation is added
       later.
      
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
    
    
      
      
      These resources do not have an independent existence apart from the resource that contains
       them - they cannot be identified independently, and nor can they have their own independent
       transaction scope.
      This should never be done when the content can be identified properly, as once identification
       is lost, it is extremely difficult (and context dependent) to restore it again.
      
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="bmi"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
    <valueMarkdown value="#### Complete Summary of the Mandatory Requirements

1.  One code in `Observation.category` which must have
    -   a fixed `Observation.category.coding.system`=**'http ://loinc.org'**
    -   a fixed  `Observation.category.coding.code`= **'39156-5'**
    -   The code (or codes) for the measurement obtained  in `Observation.code`.
     All codes
        SHALL have a system value
1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.Dat
    aAbsentReason
   - Each Observation.valueQuantity must have:
     - One numeric value in Observation.valueQuantity.value
     - a fixed Observation.valueQuantity.system=&quot;http://unitsofmeasure.org&quot;
     - a UCUM unit code in Observation.valueQuantity.code = **'kg/m2'**"/> 
  </extension>   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">    <valueInteger value="4"/>   </extension>   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">    <valueCode value="oo"/>   </extension>   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">    <valueCode value="trial-use"/>   </extension>   <extension url="http://hl7.org/fhir/tools/StructureDefinition/profile-summary">    <valueString value="#### Complete Summary of the Mandatory Requirements

1.  One code in `Observation.category` which must have
    -   a fixed `Observation.category.coding.system`=**'http ://loinc.org'**
    -   a fixed  `Observation.category.coding.code`= **'39156-5'**
    -   The code (or codes) for the measurement obtained  in `Observation.code`.

     All codes
        SHALL have a system value
1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.Dat
    aAbsentReason
   - Each Observation.valueQuantity must have:
     - One numeric value in Observation.valueQuantity.value
     - a fixed Observation.valueQuantity.system=&quot;http://unitsofmeasure.org&quot;
     - a UCUM unit code in Observation.valueQuantity.code = **'kg/m2'**"/> 
  </extension>   <url value="http://hl7.org/fhir/StructureDefinition/bmi"/>   <identifier>     <system value="urn:ietf:rfc:3986"/>     <value value="urn:oid:2.16.840.1.113883.4.642.5.1464"/>   </identifier>   <version value="6.0.0-ballot3"/>   <name value="Observationbmi"/>   <title value="Observation Body Mass Index Profile"/>   <status value="draft"/>   <experimental value="false"/>   <date value="2018-08-11"/>   <publisher value="HL7 International / Orders and Observations"/>   <contact>     <telecom>       <system value="url"/>       <value value="http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations"/>     </telecom>   </contact>   <description value="FHIR Body Mass Index (BMI) Profile"/>   <fhirVersion value="6.0.0-ballot3"/>   <mapping>     <identity value="workflow"/>     <uri value="http://hl7.org/fhir/workflow"/>     <name value="Workflow Pattern"/>   </mapping>   <mapping>     <identity value="sct-concept"/>     <uri value="http://snomed.info/conceptdomain"/>     <name value="SNOMED CT Concept Domain Binding"/>   </mapping>   <mapping>     <identity value="v2"/>     <uri value="http://hl7.org/v2"/>     <name value="HL7 V2 Mapping"/>   </mapping>   <mapping>     <identity value="rim"/>     <uri value="http://hl7.org/v3"/>     <name value="RIM Mapping"/>   </mapping>   <mapping>     <identity value="w5"/>     <uri value="http://hl7.org/fhir/fivews"/>     <name value="FiveWs Pattern Mapping"/>   </mapping>   <mapping>     <identity value="sct-attr"/>     <uri value="http://snomed.org/attributebinding"/>     <name value="SNOMED CT Attribute Binding"/>   </mapping>   <kind value="resource"/>   <abstract value="false"/>   <type value="Observation"/>   <baseDefinition value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>   <derivation value="constraint"/>   <snapshot>     <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">      <valueString value="6.0.0-ballot3"/>     </extension>     <element id="Observation">      <path value="Observation"/>       <short value="FHIR Body Mass Index (BMI) Profile"/>       <definition value="This profile defines  how to represent Body Mass Index (BMI) observations in FHIR

       using a standard LOINC code and UCUM units of measure."/> 
      <comment value="Used for simple observations such as device measurements, laboratory atomic results,

       vital signs, height, weight, smoking status, comments, etc.  Other resources are
       used to provide context for observations such as laboratory reports, etc."/> 
      <alias value="Vital Sign"/>       <alias value="Measurement"/>       <alias value="Result"/>       <alias value="Test Performed"/>       <alias value="Observable"/>       <alias value="Vital Signs"/>       <alias value="Results"/>       <alias value="Tests"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation"/>         <min value="0"/>         <max value="*"/>       </base>       <constraint>         <key value="dom-2"/>         <severity value="error"/>         <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>         <expression value="contained.contained.empty()"/>         <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>       </constraint>       <constraint>         <key value="dom-3"/>         <severity value="error"/>         <human value="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"/> 
        <expression value="contained.where((('#'+id.trace('id') in %resource.descendants().select(reference

         | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmat
        ched', id).empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>       </constraint>       <constraint>         <key value="dom-4"/>         <severity value="error"/>         <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId

         or a meta.lastUpdated"/> 
        <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>         <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>       </constraint>       <constraint>         <key value="dom-5"/>         <severity value="error"/>         <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/>         <expression value="contained.meta.security.empty()"/>         <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>       </constraint>       <constraint>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">          <valueBoolean value="true"/>         </extension>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">          <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can

           display the resource to a human safely. Including a human readable representation
           in the resource makes for a much more robust eco-system and cheaper handling of
           resources by intermediary systems. Some ecosystems restrict distribution of resources
           to only those systems that do fully understand the resources, and as a consequence
           implementers may believe that the narrative is superfluous. However experience
           shows that such eco-systems often open up to new participants over time."/> 
        </extension>         <key value="dom-6"/>         <severity value="warning"/>         <human value="A resource should have narrative for robust management"/>         <expression value="text.`div`.exists()"/>         <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>       </constraint>       <constraint>         <key value="obs-6"/>         <severity value="error"/>         <human value="Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not

         present"/> 
        <expression value="dataAbsentReason.empty() or value.empty()"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <constraint>         <key value="obs-7"/>         <severity value="error"/>         <human value="If Observation.component.code is the same as Observation.code, then Observation.value

         SHALL NOT be present (the Observation.component.value[x] holds the value)."/> 
        <expression value="value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty

        ()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <constraint>         <key value="obs-10"/>         <severity value="error"/>         <human value="Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x

        ] is not present"/> 
        <expression value="component.empty() or component.where(dataAbsentReason.exists()).all(value.empty())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <constraint>         <key value="obs-11"/>         <severity value="error"/>         <human value="if organizer exists and organizer = true, then value[x], dataAbsentReason and component

         SHALL NOT be present"/> 
        <expression value="(organizer.exists() and organizer.allTrue()) implies (value.empty() and dataAbsentReason.empt

        y() and component.empty())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <constraint>         <key value="obs-12"/>         <severity value="warning"/>         <human value="All observations SHOULD have a performer"/>         <expression value="performer.exists()"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <constraint>         <key value="vsp-1"/>         <severity value="error"/>         <human value="if Observation.effective[x] (as dateTime) has a value then that value shall be

         precise at least to the day"/> 
        <expression value="(effective as dateTime).toString().length() &gt;= 8"/>         <source value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>       </constraint>       <constraint>         <key value="vsp-2"/>         <severity value="error"/>         <human value="If there is no component or hasMember element then either a value[x] or a data

         absent reason must be present."/> 
        <expression value="(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or

         value.exists())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>       </constraint>       <constraint>         <key value="vs-4"/>         <severity value="error"/>         <human value="For single vital signs observations (that do not require use of components or hasMember),

         then either a value[x] or a data absent reason must be present."/> 
        <expression value="dataAbsentReason.exists() or value.exists()"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="Entity, Role, or Act,Observation[classCode=OBS, moodCode=EVN]"/>       </mapping>       <mapping>         <identity value="workflow"/>         <map value="Event"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="clinical.diagnostics"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 363787002 |Observable entity|"/>       </mapping>     </element>     <element id="Observation.id">      <path value="Observation.id"/>       <short value="Logical id of this artifact"/>       <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned,

       this value never changes."/> 
      <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except

       for cases like the create and conditional update. Otherwise, the use of the resouce
       id depends on the given use case."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Resource.id"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">          <valueUrl value="id"/>         </extension>         <code value="http://hl7.org/fhirpath/System.String"/>       </type>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>     </element>     <element id="Observation.meta">      <path value="Observation.meta"/>       <short value="Metadata about the resource"/>       <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.

       Changes to the content might not always be associated with version changes to the
       resource."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Resource.meta"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Meta"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>     </element>     <element id="Observation.implicitRules">      <path value="Observation.implicitRules"/>       <short value="A set of rules under which this content was created"/>       <definition value="A reference to a set of rules that were followed when the resource was constructed,

       and which must be understood when processing the content. Often, this is a reference
       to an implementation guide that defines the special rules along with other profiles
       etc. For DomainResources, if more than one implicitRules policy applies, additional
       policies may be conveyed using the [additionalImplicitRules](https://build.fhir.org/ig/HL7/fh
      ir-extensions/StructureDefinition-additionalImplicitRules.html) extension."/> 
      <comment value="Asserting this rule set restricts the content to be only understood by a limited

       set of trading partners. This inherently limits the usefulness of the data in the
       long term. However, the existing health eco-system is highly fractured, and not
       yet ready to define, collect, and exchange data in a generally computable sense.
       Wherever possible, implementers and/or specification writers should avoid using
       this element. Often, when used, the URL is a reference to an implementation guide
       that defines these special rules as part of its narrative along with other profiles,
       value sets, etc."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Resource.implicitRules"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="uri"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="true"/>       <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional

       knowledge about the resource that modifies its meaning or interpretation"/> 
      <isSummary value="true"/>     </element>     <element id="Observation.language">      <path value="Observation.language"/>       <short value="Language of the resource content"/>       <definition value="The base language in which the resource is written."/>       <comment value="Language is provided to support indexing and accessibility (typically, services

       such as text to speech use the language tag). The html language tag in the narrative
       applies  to the narrative. The language tag on the resource may be used to specify
       the language of other presentations generated from the data in the resource. Not
       all the content has to be in the base language. The Resource.language should not
       be assumed to apply to the narrative automatically. If a language is specified,
       it should it also be specified on the div element in the html (see rules in HTML5
       for information about the relationship between xml:lang and the html lang attribute)."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Resource.language"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="code"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="Language"/>         </extension>         <strength value="required"/>         <description value="IETF language tag for a human language"/>         <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3"/>         <additional>           <purpose value="starter"/>           <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>         </additional>       </binding>     </element>     <element id="Observation.text">      <path value="Observation.text"/>       <short value="Text summary of the resource, for human interpretation"/>       <definition value="A human-readable narrative that contains a summary of the resource and can be used

       to represent the content of the resource to a human. The narrative need not encode
       all the structured data, but is required to contain sufficient detail to make it
       &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions
       may define what content should be represented in the narrative to ensure clinical
       safety."/> 
      <comment value="Contained resources do not have a narrative. Resources that are not contained SHOULD

       have a narrative. In some cases, a resource may only have text with little or no
       additional discrete data (as long as all minOccurs=1 elements are satisfied). 
       This may be necessary for data from legacy systems where information is captured
       as a &quot;text blob&quot; or where text is additionally entered raw or narrated
       and encoded information is added later."/> 
      <alias value="narrative"/>       <alias value="html"/>       <alias value="xhtml"/>       <alias value="display"/>       <min value="0"/>       <max value="1"/>       <base>         <path value="DomainResource.text"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Narrative"/>       </type>       <condition value="dom-6"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="Act.text?"/>       </mapping>     </element>     <element id="Observation.contained">      <path value="Observation.contained"/>       <short value="Contained, inline Resources"/>       <definition value="These resources do not have an independent existence apart from the resource that

       contains them - they cannot be identified independently, nor can they have their
       own independent transaction scope. This is allowed to be a Parameters resource
       if and only if it is referenced by a resource that provides context/meaning."/> 
      <comment value="This should never be done when the content can be identified properly, as once

       identification is lost, it is extremely difficult (and context dependent) to restore
       it again. Contained resources may have profiles and tags in their meta elements,
       but SHALL NOT have security labels. Contained resources may be a resource type
       defined in the FHIR specification, or an [additional resource](resource.html#additional)."/> 
      <alias value="inline resources"/>       <alias value="anonymous resources"/>       <alias value="contained resources"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="DomainResource.contained"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Resource"/>       </type>       <condition value="dom-2"/>       <condition value="dom-4"/>       <condition value="dom-3"/>       <condition value="dom-5"/>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.extension">      <path value="Observation.extension"/>       <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. In order to make the use of extensions safe and manageable, there is
       a strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      

       of the resource. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="DomainResource.extension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.modifierExtension">      <path value="Observation.modifierExtension"/>       <short value="Extensions that cannot be ignored"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource, and that modifies the understanding of the element that contains it.
       Usually modifier elements provide negation or qualification. In order to make the use
       of extensions safe and manageable, there is a strict set of governance applied to the
       definition and use of extensions. Though any implementer is allowed to define an extension,
       there is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
    
    
      
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        OBX.21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR
         and OBX must be negotiated between trading partners to uniquely identify the OBX segment.
         Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3
         + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC
         + OBX-3 + OBX-4.
      
      
        
        
      
      
        
        
      
    
    
      
      
      

       of the resource and that modifies the understanding of the element that contains
       it and/or the understanding of the containing element's descendants. Usually modifier
       elements provide negation or qualification. To make the use of extensions safe
       and managable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there
       is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be

       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="DomainResource.modifierExtension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="true"/>       <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the

       resource that contains them"/> 
      <isSummary value="true"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.identifier">      <path value="Observation.identifier"/>       <short value="Business Identifier for observation"/>       <definition value="A unique identifier assigned to this observation."/>       <requirements value="Allows observations to be distinguished and referenced."/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.identifier"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Identifier"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.identifier"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.identifier"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR

         and OBX must be negotiated between trading partners to uniquely identify the OBX
         segment. Depending on how V2 has been implemented each of these may be an option:
         1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 3) some other way
         to uniquely ID the OBR/ORC + OBX-3 + OBX-4."/> 
      </mapping>       <mapping>         <identity value="rim"/>         <map value="id"/>       </mapping>     </element>     <element id="Observation.basedOn">      <path value="Observation.basedOn"/>       <short value="Fulfills plan, proposal or order"/>       <definition value="A plan, proposal or order that is fulfilled in whole or in part by this event.

        For example, a MedicationRequest may require a patient to have laboratory test
       performed before  it is dispensed."/> 

      <requirements value="Allows tracing of authorization for the event and tracking whether proposals/recommendations
       were acted upon.
      
      
      
      
        
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
        
      
      
      
      
      This element is labeled as a modifier because the status contains codes that mark the
       resource as not currently valid.
      Need to track the status of individual results. Some results are finalized before the
       whole report is finalized.
      
      
      
        
        
        
      
      
        
      
      
      
      
      
        
          
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct
         event with a type of &quot;revise&quot;
      
      
        
        
      
    
    
      
      
      
      In addition to the required category valueset, this element allows various categorization
       schemes based on the owner’s definition of the category and effectively multiple categories
       can be used at once.  The level of granularity is defined by the category concepts in
       the value set.
      
      
      
      
        
        
        
      
      
        
      
      
        
        
        
        where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists
        ()
        exists(f:coding/code[@value='vital-signs']) and exists(f:coding/system[@value='http://hl7.org/fhir/o
        bservation-category'])
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        .outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quo
        t;].code
      
      
        
        
      
    
    
      
      
      
      additional codes that translate or map to this code are allowed.  For example a more granular
       LOINC code or code that is used locally in a system.
      5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet
       HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
        
          
          
        
        
        
      
      

       were acted upon."/> 
      <alias value="Fulfills"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.basedOn"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.basedOn"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="ORC"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/>       </mapping>     </element>     <element id="Observation.triggeredBy">      <path value="Observation.triggeredBy"/>       <short value="Triggering observation(s)"/>       <definition value="Identifies the observation(s) that triggered the performance of this observation."/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.triggeredBy"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="BackboneElement"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children or both"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="ORC"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/>       </mapping>     </element>     <element id="Observation.triggeredBy.id">      <path value="Observation.triggeredBy.id"/>       <representation value="xmlAttr"/>       <short value="Unique id for inter-element referencing"/>       <definition value="Unique id for the element within a resource (for internal references). This may

       be any string value that does not contain spaces."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Element.id"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">          <valueUrl value="string"/>         </extension>         <code value="http://hl7.org/fhirpath/System.String"/>       </type>       <condition value="ele-1"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.triggeredBy.extension">      <path value="Observation.triggeredBy.extension"/>       <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
        
          
          
        
        
        
      
      
      
      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
       such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of
       codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
       of the coding values will be labeled as UserSelected = true.
      Allows for translations and alternate encodings within a code system.  Also supports communication
       of the same instance to systems requiring different encodings.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      
      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
       such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of
       codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
       of the coding values will be labeled as UserSelected = true.
      Allows for translations and alternate encodings within a code system.  Also supports communication
       of the same instance to systems requiring different encodings.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
        
          
          
        
        
        
      
      

       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Element.extension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.triggeredBy.modifierExtension">      <path value="Observation.triggeredBy.modifierExtension"/>       <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      
      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be
       references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of
       FHIR defined special URIs or it should de-reference to some definition that establish
       the system clearly and unambiguously.
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The version of the code system which was used when choosing this code. Note that a well-maintained
       code system does not need the version reported, because the meaning of codes is consistent
       across versions. However this cannot consistently be assured. and when the meaning is
       not guaranteed to be consistent, the version SHOULD be exchanged.
      Where the terminology does not clearly define what string should be used to identify code
       system versions, the recommendation is to use the date (expressed in FHIR date format)
       on which that version was officially published as the version date.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression
       in a syntax defined by the coding system (e.g. post-coordination).
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
        
      
      
      
      A representation of the meaning of the code in the system, following the rules of the
       system.
      Need to be able to carry a human-readable meaning of the code for readers that do not
       know  the system.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      Indicates that this coding was chosen by a user directly - i.e. off a pick list of available
       items (codes or displays).
      Amongst a set of alternatives, a directly chosen code is the most appropriate starting
       point for new translations. There is some ambiguity about what exactly 'directly chosen'
       implies, and trading partner agreement may be needed to clarify the use of this element
       and its consequences more completely.
      This has been identified as a clinical safety criterium - that this exact system/code
       pair was chosen explicitly, rather than inferred by the system based on some rules or
       language processing.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected
         fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target
         dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;
             fhir:target dt:CDCoding.codingRationale\#O   ]
      
    
    
      
        
      
      
      
      A human language representation of the concept as seen/selected/uttered by the user who
       entered the data and/or which represents the intended meaning of the user.
      
      The codes from the terminologies do not always capture the correct meaning with all the
       nuances of the human using them, or sometimes there is no appropriate code at all. In
       these cases, the text is used to capture the full meaning of the source.
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The patient, or group of patients, location, or device whose characteristics (direct or
       indirect) are described by the observation and into whose record the observation is placed.
        Comments: Indirect characteristics may be those of a specimen, fetus, donor,  other observer
       (for example a relative or EMT), or any observation made about the subject.
      One would expect this element to be a cardinality  of 1..1.  The only circumstance in
       which the subject can be missing is when the observation is made by a device that does
       not know the patient. In this case, the observation SHALL be matched to a patient through
       some context/channel matching technique, and at this point, the observation should be
       updated.

If the target of the observation is different than the subject, the general extension
       [observation-focal-subject](extension-observation-focal-subject.html).  may be used. 
       However, the distinction between the patient's own value for an observation versus that
       of the fetus, or the donor or blood product unit, etc., are often specified in the observation
       code.
      
      
      
      
        
        
        
      
      
        
        
      
      
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The healthcare event  (e.g. a patient and healthcare provider interaction) during which
       this observation is made.
      This will typically be the encounter the event occurred within, but some events may be
       initiated prior to or after the official completion of an encounter or episode but still
       be tied to the context of the encounter or episode (e.g. pre-admission lab tests).
      For some observations it may be important to know the link between an observation and
       a particular encounter.
      
      
      
      
        
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      
      Knowing when an observation was deemed true is important to its relevance as well as determining
       trends.
      
      
      
      
        
        
        
      
      
        
      
      
        
      
      
        
        
        
        
        
      
      
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The date and time this observation was made available to providers, typically after the
       results have been reviewed and verified.
      
      
      
      
        
        
        
      
      
        
      
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      

       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be

       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <alias value="modifiers"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="BackboneElement.modifierExtension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="true"/>       <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the

       element that contains them"/> 
      <isSummary value="true"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.triggeredBy.observation">      <path value="Observation.triggeredBy.observation"/>       <short value="Triggering observation"/>       <definition value="Reference to the triggering observation."/>       <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.triggeredBy.observation"/>         <min value="1"/>         <max value="1"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="rim"/>         <map value="outBoundRelationship"/>       </mapping>     </element>     <element id="Observation.triggeredBy.type">      <path value="Observation.triggeredBy.type"/>       <short value="reflex | repeat | re-run"/>       <definition value="The type of trigger.
Reflex | Repeat | Re-run."/> 
      <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.triggeredBy.type"/>         <min value="1"/>         <max value="1"/>       </base>       <type>         <code value="code"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="TriggeredByType"/>         </extension>         <strength value="required"/>         <description value="The type of TriggeredBy Observation."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-triggeredbytype|6.0.0-ballot3"/>       </binding>       <mapping>         <identity value="rim"/>         <map value="code"/>       </mapping>     </element>     <element id="Observation.triggeredBy.reason">      <path value="Observation.triggeredBy.reason"/>       <short value="Reason that the observation was triggered"/>       <definition value="Provides the reason why this observation was performed as a result of the observation(s)

       referenced."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.triggeredBy.reason"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="string"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="annotation"/>       </mapping>     </element>     <element id="Observation.partOf">      <path value="Observation.partOf"/>       <short value="Part of referenced event"/>       <definition value="A larger event of which this particular Observation is a component or step.  For

       example,  an observation as part of a procedure."/> 
      <comment value="To link an Observation to an Encounter use `encounter`.  See the  [Notes](observation.html#ob

      sgrouping) below for guidance on referencing another Observation."/> 
      <alias value="Container"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.partOf"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationDispense"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationStatement"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Immunization"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/GenomicStudy"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.partOf"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="Varies by domain"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".outboundRelationship[typeCode=FLFS].target"/>       </mapping>     </element>     <element id="Observation.status">      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">        <valueString value="default: final"/>       </extension>       <path value="Observation.status"/>       <short value="registered | specimen-in-process | preliminary | final | amended | corrected |

       appended | cancelled | entered-in-error | unknown | cannot-be-obtained"/> 
      <definition value="The status of the result value."/>       <comment value="This element is labeled as a modifier because the status contains codes that mark

       the resource as not currently valid."/> 
      <requirements value="Need to track the status of individual results. Some results are finalized before

       the whole report is finalized."/> 
      <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.status"/>         <min value="1"/>         <max value="1"/>       </base>       <type>         <code value="code"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="true"/>       <isModifierReason value="This element is labeled as a modifier because it is a status element that contains

       status entered-in-error which means that the resource should not be treated as
       valid"/> 
      <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationStatus"/>         </extension>         <strength value="required"/>         <description value="Codes providing the status of an observation."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-status|6.0.0-ballot3"/>       </binding>       <mapping>         <identity value="workflow"/>         <map value="Event.status"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.status"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-11 Map FHIR Observation.status to OBX-11. If FHIR carries Observation.dataAbsentReason

         = ‘not-asked’, set OBX-11 to the v2 as  ‘N’. If there is alternate-code extension
         on Observation.status with code ‘X’, set OBX-11 as ‘X’."/> 
      </mapping>       <mapping>         <identity value="rim"/>         <map value="status  Amended &amp; Final are differentiated by whether it is the subject of

         a ControlAct event with a type of &quot;revise&quot;"/> 
      </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 445584004 |Report by finality status|"/>       </mapping>     </element>     <element id="Observation.category">      <path value="Observation.category"/>       <slicing>         <discriminator>           <type value="pattern"/>           <path value="$this"/>         </discriminator>         <rules value="open"/>       </slicing>       <short value="Classification of  type of observation"/>       <definition value="A code that classifies the general type of observation being made."/>       <comment value="In addition to the required category valueset, this element allows various categorization

       schemes based on the owner’s definition of the category and effectively multiple
       categories can be used at once.  The level of granularity is defined by the category
       concepts in the value set."/> 
      <requirements value="Used for filtering what observations are retrieved and displayed."/>       <min value="1"/>       <max value="*"/>       <base>         <path value="Observation.category"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationCategory"/>         </extension>         <strength value="preferred"/>         <description value="Codes for high level observation categories."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>       </binding>       <mapping>         <identity value="workflow"/>         <map value="Event.category"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.class"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-29"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;

        EVN&quot;].code"/> 
      </mapping>     </element>     <element id="Observation.category:VSCat">      <path value="Observation.category"/>       <sliceName value="VSCat"/>       <short value="Classification of  type of observation"/>       <definition value="A code that classifies the general type of observation being made as a vital sign

       related observation, whether a point-in-time or calculated vital sign observation.
       "/>       <comment value="In addition to the required category valueset, this element allows various categorization

       schemes based on the owner’s definition of the category and effectively multiple
       categories can be used at once.  The level of granularity is defined by the category
       concepts in the value set."/> 
      <requirements value="Used for filtering what observations are retrieved and displayed."/>       <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.category"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <patternCodeableConcept>         <coding>           <system value="http://terminology.hl7.org/CodeSystem/observation-category"/>           <code value="vital-signs"/>         </coding>       </patternCodeableConcept>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationCategory"/>         </extension>         <strength value="preferred"/>         <description value="Codes for high level observation categories."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>       </binding>       <mapping>         <identity value="workflow"/>         <map value="Event.category"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.class"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-29"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;

        EVN&quot;].code"/> 
      </mapping>     </element>     <element id="Observation.code">      <path value="Observation.code"/>       <short value="Body Mass Index (BMI)"/>       <definition value="Body Mass Index (BMI)"/>       <comment value="*All* code-value and, if present, component.code-component.value pairs need to

       be taken into account to correctly understand the meaning of the observation. All
       codings in Observation.code are expected to be sufficiently precise to allow a
       user with the code and value to be able to understand the value - though not all
       codes will necessarily convey the same level of detail. Codings in Observation.category
       SHOULD be concepts that are too broad to be able to understand the meaning of the
       Observation.value without also having an Observation.code.
See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop)
       for additional information."/> 
      <requirements value="Knowing what kind of observation is being made is essential to understanding the

       observation."/> 
      <alias value="Name"/>       <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.code"/>         <min value="1"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <patternCodeableConcept>         <coding>           <system value="http://loinc.org"/>           <code value="39156-5"/>         </coding>       </patternCodeableConcept>       <condition value="obs-7"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="VitalSignsBMI"/>         </extension>         <strength value="preferred"/>         <description value="This identifies the set of LOINC codes that are appropriate for representing body

         mass index (BMI) vital sign measurements in Observation.code."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsign-bmi"/>       </binding>       <mapping>         <identity value="workflow"/>         <map value="Event.code"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.what[x]"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-3"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="code"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|"/>       </mapping>     </element>     <element id="Observation.subject">      <path value="Observation.subject"/>       <short value="Who and/or what the observation is about"/>       <definition value="The patient, or group of patients, location, device, organization, procedure or

       practitioner this observation is about and into whose or what record the observation
       is placed. If the actual focus of the observation is different from the subject
       (or a sample of, part, or region of the subject), the `focus` element or the `code`
       itself specifies the actual focus of the observation."/> 
      <comment value="One would expect this element to be a cardinality of 1..1. The only circumstance

       in which the subject can be missing is when the observation is made by a device
       that does not know the patient. In this case, the observation SHALL be matched
       to a patient through some context/channel matching technique, and at this point,
       the observation should be updated. The subject of an Observation may in some cases
       be a procedure.  This supports the regulatory inspection use case where observations
       are captured during inspections of a procedure that is being performed (independent
       of any particular patient or whether patient related at all)."/> 
      <requirements value="Observations have no value if you don't know who or what they're about."/>       <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.subject"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.subject"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.subject"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="PID-3"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=RTGT]"/>       </mapping>     </element>     <element id="Observation.focus">      <path value="Observation.focus"/>       <short value="What the observation is about, when it is not about the subject of record"/>       <definition value="The actual focus of an observation when it is not the subject of record representing

       something or someone associated with the patient such as a spouse, parent, fetus,
       or donor. For example, fetus observations in a mother's record.  The focus of an
       observation could also be an existing condition,  an intervention, the subject's
       diet,  another observation of the subject,  or a body structure such as tumor or
       implanted device.   An example use case would be using the Observation resource
       to capture whether the mother is trained to change her child's tracheostomy tube.
       In this example, the child is the patient of record and the mother is the focus.
       As another use case,

a caregiver (RelatedPerson) has back strain and is unable to provide ADL support
       to a patient (Subject)."/> 
      <comment value="Examples demonstrating the use of subject and focus in an Observation:

- A parent is trained to change their child's tracheostomy tube. The child is the

       subject, and the parent is the focus.

- A fetal heart rate recorded in a mother's record. The mother is the subject,
       and the fetus is the focus.

- Features of a body structure, such as a tumor. The patient is the subject, and
       the specific body structure is the focus.

- Metrics captured from a medical device. The patient-attached device is the subject,
       the specific device metric is the focus, and the observing device itself is referenced
       in .device."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.focus"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="true"/>       <isModifierReason value="This element is labeled as a modifier because it changes who is the target of the

       observation. See the use cases in the definition."/> 
      <isSummary value="true"/>       <mapping>         <identity value="w5"/>         <map value="FiveWs.subject"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-3"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=SBJ]"/>       </mapping>     </element>     <element id="Observation.organizer">      <path value="Observation.organizer"/>       <short value="This observation organizes/groups a set of sub-observations"/>       <definition value="This observation serves as an organizer or grouper for a set of (one or more) sub-observation

      s."/> 
      <comment value="An observation that is an organizer/grouper does not have a value (or dataAbsentReason)

       of its own - all values are included in the sub-observations.  The sub-observations
       are linked using hasMember element references (in some instances there may be no
       hasMember references, as it is possible that the organizer/grouper observation
       may be created first, and the sub-observations are not created until a later time).
        An organizer/grouper observation also does not contain any components."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.organizer"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="boolean"/>       </type>       <condition value="obs-11"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>     </element>     <element id="Observation.encounter">      <path value="Observation.encounter"/>       <short value="Healthcare event during which this observation is made. If you need to place the

       observation within one or more episodes of care, use the workflow-episodeOfCare
       extension"/> 
      <definition value="The healthcare event  (e.g. a patient and healthcare provider interaction) during

       which this observation is made."/> 
      <comment value="This will typically be the encounter the event occurred within, but some events

       may be initiated prior to or after the official completion of an encounter but
       still be tied to the context of the encounter (e.g. pre-admission laboratory tests)."/> 
      <requirements value="For some observations it may be important to know the link between an observation

       and a particular encounter."/> 
      <alias value="Context"/>       <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.encounter"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.encounter"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.context"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="PV1"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>       </mapping>     </element>     <element id="Observation.effective[x]">      <path value="Observation.effective[x]"/>       <short value="Vital Signs are point in time measurements and are recorded using the dateTime

       data type"/> 
      <definition value="Vital Signs are point in time measurements and are recorded using the dateTime

       data type."/> 
      <comment value="At least a date should be present unless this observation is a historical report.

        For recording imprecise or &quot;fuzzy&quot; times (For example, a blood glucose
       measurement taken &quot;after breakfast&quot;) use the [Timing](datatypes.html#timing)
       datatype which allow the measurement to be tied to regular life events."/> 
      <requirements value="Knowing when an observation was deemed true is important to its relevance as well

       as determining trends."/> 
      <alias value="Occurrence"/>       <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.effective[x]"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="dateTime"/>       </type>       <condition value="vsp-1"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.occurrence[x]"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.done[x]"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-14 (If Observation carries the AnalysisDateTime extension, then map the extension

         to OBX-19)"/> 
      </mapping>       <mapping>         <identity value="rim"/>         <map value="effectiveTime"/>       </mapping>     </element>     <element id="Observation.issued">      <path value="Observation.issued"/>       <short value="Date/Time this version was made available"/>       <definition value="The date and time this version of the observation was made available to providers,

       typically after the results have been reviewed and verified."/> 
      <comment value="For Observations that don't require review and verification, it may be the same

       as the [`lastUpdated` ](resource-definitions.html#Meta.lastUpdated) time of the
       resource itself.  For Observations that do require review and verification for
       certain updates, it might not be the same as the `lastUpdated` time of the resource
       itself due to a non-clinically significant update that doesn't require the new
       version to be reviewed and verified again."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.issued"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="instant"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="w5"/>         <map value="FiveWs.recorded"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBR-22 (or MSH-7), or perhaps OBX-19 (depends on who observation made)"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=AUT].time"/>       </mapping>     </element>     <element id="Observation.performer">      <path value="Observation.performer"/>       <short value="Who is responsible for the observation"/>       <definition value="Who was responsible for asserting the observed value as &quot;true&quot;."/>       <comment value="Group is only allowed in the circumstance where the group represents a family or

       a household, and should not represent groups of Practitioners where other more
       specific resources can be used instead."/> 

      <requirements value="May give a degree of confidence in the observation and also indicates where follow-up
       questions should be directed.
      
      
      
        
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
      
        
        
      
      
        
        OBX.15 / (Practitioner)  OBX-16,  PRT-5:PRT-4='RO' /  (Device)  OBX-18 , PRT-10:PRT-4='EQUIP'
         / (Organization)  OBX-23,  PRT-8:PRT-4='PO'
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Normally, an observation will have either a single value or a set of related observations.
       A few observations (e.g. Apgar score) may have both a value and related observations (for
       an Apgar score, the observations from which the measure is derived). If a value is present,
       the datatype for this element should be determined by Observation.code. This element has
       a variable name depending on the type as follows: valueQuantity, valueCodeableConcept,
       valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment,
       valueTime, valueDateTime, or valuePeriod. (The name format is &quot;'value' + the type
       name&quot; with a capital on the first letter of the type).


If the data element is usually coded or if the type associated with the Observation.value
       defines a coded value, use CodeableConcept instead of string datatype even if the value
       is uncoded text.  A value set is bound to the ValueCodeableConcept element.    For further
       discussion and examples see the  [notes section](observation.html#notes) below.
      
      
      
      
        
        
        
      
      
        
      
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
        
          
          
        
        
        
      
      
      May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      The value of the measured amount. The value includes an implicit precision in the presentation
       of the value.
      The implicit precision in the value should always be honored. Monetary values have their
       own rules for handling precision (refer to standard accounting text books).
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      How the value should be understood and represented - whether the actual value is greater
       or less than the stated value due to measurement issues; e.g. if the comparator is &quot;&lt;&quot;
       , then the real value is &lt; stated value.
      This is labeled as &quot;Is Modifier&quot; because the comparator modifies the interpretation
       of the value significantly. If there is no comparator, then there is no modification of
       the value.
      Need a framework for handling measures where the value is &lt;5ug/L or &gt;400mg/L due
       to the limitations of measuring methodology.
      
      
      
        
        
        
      
      
        
      
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
    
    
      
        
      
      
      
      
      There are many representations for units of measure and in many contexts, particular representations
       are fixed and required. I.e. mcg for micrograms.
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or
       ISO 4217 for currency.  The context of use may additionally require a code from a particular
       system.
      Need a computable form of the unit that is fixed across all forms. UCUM provides this
       for quantities, but SNOMED CT provides many units of interest.
      
      
      
        
        
        
      
      
        
      
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Null or exceptional values can be represented two ways in FHIR Observations.  One way
       is to simply include them in the value set and represent the exceptions in the value.
        For example, measurement values for a serology test could be  &quot;detected&quot;, &quot;not
       detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   The
       alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed. Note that
       an observation may only be reported if there are values to report. For example differential
       cell counts values may be reported only when &gt; 0.  Because of these options, use-case
       agreements are required to interpret general observations for null or exceptional values.
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The assessment made based on the result of the observation.  Intended as a simple compact
       code often placed adjacent to the result value in reports and flow sheets to signal the
       meaning/normalcy status of the result. Otherwise known as abnormal flag.
      For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result.
      
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      May include statements about significant, unexpected or unreliable values, or information
       about the source of the value where this may be relevant to the interpretation of the
       result.
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      Indicates the site on the subject's body where the observation was made (i.e. the target
       site).
      Only used if not implicit in code found in Observation.code.  In many systems, this may
       be represented as a related observation instead of an inline component.   If the use case
       requires BodySite to be handled as a separate resource (e.g. to identify and track separately)
       then use the standard extension[ body-site-instance](extension-body-site-instance.html).
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      
      In some cases, method can impact results and is thus used for determining whether results
       can be compared or determining significance of results.
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Should only be used if not implicit in code found in `Observation.code`.  Observations
       are not made on specimens themselves; they are made on a subject, but in many cases by
       the means of a specimen. Note that although specimens are often involved, they are not
       always tracked and reported explicitly. Also note that observation resources may be used
       in contexts that track the specimen explicitly (e.g. Diagnostic Report).
      
      
      
        
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      An extension should be used if further typing of the device is needed.  Devices used to
       support obtaining an observation can be represented using either an extension or through
       the Observation.related element.
      
      
      
        
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.,
       specific to the patient's age, gender, weight and other factors), but this may not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties.

       questions should be directed."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.performer"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/CareTeam"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/HealthcareService"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="workflow"/>         <map value="Event.performer.actor"/>       </mapping>       <mapping>         <identity value="w5"/>         <map value="FiveWs.actor"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-15, OBX-16, OBX-23, OBX-24, OBX-25. Person/role → OBX-16 (Responsible Observer).

         If conveying performing org and medical director: use OBX-25 (XCN) for the director
         with role code “MDIR” (system v2-0912), and OBX-23/24 for org name/address; if
         there is no director, OBX-23/24 carry the org. OBX-15 is available for producer
         id (identifier for the producer)."/> 
      </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=PRF]"/>       </mapping>     </element>     <element id="Observation.value[x]">      <path value="Observation.value[x]"/>       <slicing>         <discriminator>           <type value="type"/>           <path value="$this"/>         </discriminator>         <ordered value="false"/>         <rules value="closed"/>       </slicing>       <short value="The quantity for the vital sign being observed."/>       <definition value="The quantity for the vital sign being observed."/>       <comment value="- An observation may have:
  1.  a single value here
  1.  both a value and a set of related or component values
  1.  only a set of related or component values.
-  If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- The usage of valueReference is restricted to the MolecularDefinition resources
       as a definitional resource, not as a patient-specific finding. 
- For additional guidance, see the [Notes section](observation.html#notes) below.
       
- See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop)
       for additional information."/> 
      <requirements value="An observation exists to have a value, though it might not if it is in error, or

       if it represents a group of observations."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.value[x]"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <condition value="obs-7"/>       <condition value="obs-6"/>       <condition value="obs-11"/>       <condition value="vsp-2"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="VitalSignsUnits"/>         </extension>         <strength value="preferred"/>         <description value="Commonly encountered UCUM units for recording Vital Signs."/>         <valueSet value="http://hl7.org/fhir/ValueSet/ucum-vitals-common"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-2, OBX-5, OBX-6"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363714003 |Interprets|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 441742003 |Evaluation finding|"/>       </mapping>     </element>     <element id="Observation.value[x]:valueQuantity">      <path value="Observation.value[x]"/>       <sliceName value="valueQuantity"/>       <short value="The quantity for the vital sign being observed."/>       <definition value="The quantity for the vital sign being observed."/>       <comment value="- An observation may have:
  1.  a single value here
  1.  both a value and a set of related or component values
  1.  only a set of related or component values.
-  If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- The usage of valueReference is restricted to the MolecularDefinition resources
       as a definitional resource, not as a patient-specific finding. 
- For additional guidance, see the [Notes section](observation.html#notes) below.
       
- See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop)
       for additional information."/> 
      <requirements value="An observation exists to have a value, though it might not if it is in error, or

       if it represents a group of observations."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.value[x]"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <condition value="obs-7"/>       <condition value="obs-6"/>       <condition value="obs-11"/>       <condition value="vsp-2"/>       <condition value="vsp-4"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/tools/StructureDefinition/binding-definition">          <valueString value="Common UCUM units for BMI."/>         </extension>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="BMIUnits"/>         </extension>         <strength value="required"/>         <description value="kg/m2"/>         <valueSet value="http://hl7.org/fhir/ValueSet/ucum-bmi"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-2, OBX-5, OBX-6"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363714003 |Interprets|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 441742003 |Evaluation finding|"/>       </mapping>     </element>     <element id="Observation.dataAbsentReason">      <path value="Observation.dataAbsentReason"/>       <short value="Why the result value is missing"/>       <definition value="Provides a reason why the expected value in the element Observation.value[x] is

       missing."/> 
      <comment value="Null or exceptional values can be represented two ways in FHIR Observations.  One

       way is to simply include them in the value set and represent the exceptions in
       the value.  For example, measurement values for a serology test could be  &quot;detected&quot
      ;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;
      .   
The alternate way is to use the value element for actual observations and use the
       explicit dataAbsentReason element to record exceptional values.  For example, the
       dataAbsentReason code &quot;error&quot; could be used when the measurement was
       not completed."/> 
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/>       <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.dataAbsentReason"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <condition value="obs-6"/>       <condition value="obs-11"/>       <condition value="vsp-2"/>       <condition value="vsp-4"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="true"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationValueAbsentReason"/>         </extension>         <strength value="extensible"/>         <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/>         <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-32, OBX-11. Map Observation.dataAbsentReason to OBX-32 (Observation Value Absent

         Reason). Additionally, when dataAbsentReason.code = 'not-asked', also set OBX-11
         = 'N'."/> 
      </mapping>       <mapping>         <identity value="rim"/>         <map value="value.nullFlavor"/>       </mapping>     </element>     <element id="Observation.interpretation">      <path value="Observation.interpretation"/>       <short value="High, low, normal, etc"/>       <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/>       <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use

       extends to other use cases where coded interpretations  are relevant.  Often reported
       as one or more simple compact codes this element is often placed adjacent to the
       result value in reports and flow sheets to signal the meaning/normalcy status of
       the result."/> 
      <requirements value="For some results, particularly numeric results, an interpretation is necessary

       to fully understand the significance of a result."/> 
      <alias value="Abnormal Flag"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.interpretation"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationInterpretation"/>         </extension>         <strength value="extensible"/>         <description value="Codes identifying interpretations of observations."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-8"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="interpretationCode"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363713009 |Has interpretation|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 260245000 |Findings values|"/>       </mapping>     </element>     <element id="Observation.interpretationContext">      <path value="Observation.interpretationContext"/>       <short value="Context for understanding the observation"/>       <definition value="Other preceding or concurrent information that is critical to understand the context

       and significance of the observation."/> 
      <comment value="This element provides essential contextual information that affects how the observation

       should be interpreted. For example, knowing that a patient is diabetic, fasting,
       or paraplegic may be critical to properly understanding lab results or other observations."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.interpretationContext"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableReference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationInterpretationContext"/>         </extension>         <strength value="example"/>         <description value="Codes identifying contextual factors that affect interpretation of observations."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation-context"/>       </binding>       <mapping>         <identity value="rim"/>         <map value=".outboundRelationship[typeCode=PERT].target"/>       </mapping>     </element>     <element id="Observation.note">      <path value="Observation.note"/>       <short value="Comments about the observation"/>       <definition value="Comments about the observation or the results."/>       <comment value="May include general statements about the observation, or statements about significant,

       unexpected or unreliable results values, or information about its source when relevant
       to its interpretation."/> 
      <requirements value="Need to be able to provide free text additional information."/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.note"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Annotation"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="workflow"/>         <map value="Event.note"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="NTE-3 (partner NTE to OBX, or sometimes another (child?) OBX)"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/>       </mapping>     </element>     <element id="Observation.bodySite">      <path value="Observation.bodySite"/>       <short value="DEPRECATED: Observed body part"/>       <definition value="DEPRECATED: This element is deprecated. Use bodyStructure instead. Indicates the

       site on the subject's body where the observation was made (i.e. the target site)."/> 
      <comment value="DEPRECATED: Use bodyStructure instead. Only used if not implicit in code found

       in Observation.code.  In many systems, this may be represented as a related observation
       instead of an inline component."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.bodySite"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="BodySite"/>         </extension>         <strength value="example"/>         <description value="SNOMED CT Body site concepts"/>         <valueSet value="http://hl7.org/fhir/ValueSet/body-site"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-20"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="targetSiteCode"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="718497002 |Inherent location|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 123037004 |Body structure|"/>       </mapping>     </element>     <element id="Observation.bodyStructure">      <path value="Observation.bodyStructure"/>       <short value="Observed body structure"/>       <definition value="Indicates the body structure on the subject's body where the observation was made

       (i.e. the target site)."/> 
      <comment value="Only used if not implicit in code found in Observation.code. In many systems, this

       may be represented as a related observation instead of an inline component. Use
       this element instead of the deprecated bodySite element."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.bodyStructure"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableReference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/BodyStructure"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="BodyStructure"/>         </extension>         <strength value="example"/>         <description value="SNOMED CT Body Structures"/>         <valueSet value="http://hl7.org/fhir/ValueSet/body-site"/>       </binding>       <mapping>         <identity value="rim"/>         <map value="targetSiteCode"/>       </mapping>     </element>     <element id="Observation.method">      <path value="Observation.method"/>       <short value="How it was done"/>       <definition value="Indicates the mechanism used to perform the observation."/>       <comment value="Only used if not implicit in code for Observation.code."/>       <requirements value="In some cases, method can impact results and is thus used for determining whether

       results can be compared or determining significance of results."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.method"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationMethod"/>         </extension>         <strength value="example"/>         <description value="Methods for simple observations."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-methods"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-17"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="methodCode"/>       </mapping>     </element>     <element id="Observation.specimen">      <path value="Observation.specimen"/>       <short value="Specimen used for this observation"/>       <definition value="The specimen that was used when this observation was made."/>       <comment value="SHOULD be used when the observation is performed on a specimen. The type of specimen

       SHOULD be consistent with anything implied in the `Observation.code` value."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.specimen"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <constraint>         <key value="obs-9"/>         <severity value="error"/>         <human value="If Observation.specimen is a reference to Group, the group can only have specimens"/>         <expression value="(reference.resolve().exists() and reference.resolve() is Group) implies reference.resolve().m

        ember.entity.resolve().all($this is Specimen)"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="SPM segment (OBX-33 for Specimen.identifier mapping)"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=SPC].specimen"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="704319004 |Inherent in|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 123038009 |Specimen|"/>       </mapping>     </element>     <element id="Observation.device">      <path value="Observation.device"/>       <short value="A reference to the device that generates the measurements or the device settings

       for the device"/> 
      <definition value="A reference to the device that generates the measurements or the device settings

       for the device."/> 
      <comment value="Note that this is not meant to represent a device involved in the transmission

       of the result, e.g., a gateway.  Such devices may be documented using the Provenance
       resource where relevant."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.device"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-18 / PRT -10"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="participation[typeCode=DEV]"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="424226004 |Using device|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 49062001 |Device|"/>       </mapping>     </element>     <element id="Observation.referenceRange">      <path value="Observation.referenceRange"/>       <short value="Provides guide for interpretation"/>       <definition value="Guidance on how to interpret the value by comparison to a normal or recommended

       range.  Multiple reference ranges are interpreted as an &quot;OR&quot;.   In other
       words, to represent two distinct target populations, two `referenceRange` elements
       would be used."/> 
      <comment value="Most observations only have one generic reference range. Systems MAY choose to

       restrict to only        supplying the relevant reference range based on knowledge
       about the patient (e.g., specific to the patient's age,        gender, weight and
       other factors), but this might not be possible or appropriate. Whenever more than
       one reference        range is supplied, the differences between them SHOULD be
       provided in the reference range and/or age properties."/> 

      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts.
      
      
      
        
        
        
      
      
        
      
      
        
        
        
        
        
        
      
      
        
        
        
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      

       of a particular result. Need to be able to provide multiple reference ranges for
       different contexts."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.referenceRange"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="BackboneElement"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children or both"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <constraint>         <key value="obs-3"/>         <severity value="error"/>         <human value="Must have at least a low or a high or text"/>         <expression value="low.exists() or high.exists() or text.exists()"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>       </mapping>     </element>     <element id="Observation.referenceRange.id">      <path value="Observation.referenceRange.id"/>       <representation value="xmlAttr"/>       <short value="Unique id for inter-element referencing"/>       <definition value="Unique id for the element within a resource (for internal references). This may

       be any string value that does not contain spaces."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Element.id"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">          <valueUrl value="string"/>         </extension>         <code value="http://hl7.org/fhirpath/System.String"/>       </type>       <condition value="ele-1"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.referenceRange.extension">      <path value="Observation.referenceRange.extension"/>       <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      

       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Element.extension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.referenceRange.modifierExtension">      <path value="Observation.referenceRange.modifierExtension"/>       <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
    
    
      
      
      The value of the low bound of the reference range.  The low bound of the reference range
       endpoint is inclusive of the value (e.g.  reference range is &gt;=5 - &lt;=9).   If the
       low bound is omitted,  it is assumed to be meaningless (e.g. reference range is &lt;=2.3).
      
      
      
        
        
        
      
      
        
        
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      The value of the high bound of the reference range.  The high bound of the reference range
       endpoint is inclusive of the value (e.g.  reference range is &gt;=5 - &lt;=9).   If the
       high bound is omitted,  it is assumed to be meaningless (e.g. reference range is &gt;=
       2.3).
      
      
      
        
        
        
      
      
        
        
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      Codes to indicate the what part of the targeted reference population it applies to. For
       example, the normal or therapeutic range.
      This SHOULD be populated if there is more than one range.  If this element is not present
       then the normal range is assumed.
      Need to be able to say what kind of reference range this is - normal, recommended, therapeutic,
       etc,  - for proper interpretation.
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      

       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be

       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <alias value="modifiers"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="BackboneElement.modifierExtension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="true"/>       <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the

       element that contains them"/> 
      <isSummary value="true"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.referenceRange.low">      <path value="Observation.referenceRange.low"/>       <short value="Low Range, if relevant"/>       <definition value="The value of the low bound of the reference range."/>       <comment value="When low.comparator is not populated (the low.comparator element was not available

       prior to        FHIR R6), the low bound of the reference range endpoint is inclusive
       of the value (e.g., reference range is        '&gt;=5' - '&lt;=9').  Alternatively,
       this can be specified explicitly by populating low.comparator = '&gt;='.      
         When the low bound of the reference range endpoint is intended to be exclusive
       of the value (e.g., reference range        is '&gt;5' - '&lt;9'), this is specified
       with low.comparator = '&gt;'.  If the low bound is omitted,  it is        assumed
       to be meaningless (e.g., reference range is '&lt;=2.3')."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.low"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <condition value="obs-3"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <constraint>         <key value="obs-13"/>         <severity value="error"/>         <human value="If low.comparator exists, it must be '&gt;=' or '&gt;'."/>         <expression value="comparator.exists() implies (comparator = '&gt;=' or comparator = '&gt;')"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value:IVL_PQ.low"/>       </mapping>     </element>     <element id="Observation.referenceRange.high">      <path value="Observation.referenceRange.high"/>       <short value="High Range, if relevant"/>       <definition value="The value of the high bound of the reference range."/>       <comment value="When high.comparator is not populated (the high.comparator element was not available

       prior to        FHIR R6), the high bound of the reference range endpoint is inclusive
       of the value (e.g., reference range is        '&gt;=5' - '&lt;=9').  Alternatively,
       this can be specified explicitly by populating high.comparator = '&lt;='.     
          When the high bound of the reference range endpoint is intended to be exclusive
       of the value (e.g., reference range        is '&gt;5' - '&lt;9'), this is specified
       with high.comparator = '&lt;'.  If the high bound is omitted,  it is        assumed
       to be meaningless (e.g., reference range is '&gt;=2.3')."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.high"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <condition value="obs-3"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <constraint>         <key value="obs-14"/>         <severity value="error"/>         <human value="If high.comparator exists, it must be '&lt;=' or '&lt;'."/>         <expression value="comparator.exists() implies (comparator = '&lt;=' or comparator = '&lt;')"/>         <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value:IVL_PQ.high"/>       </mapping>     </element>     <element id="Observation.referenceRange.normalValue">      <path value="Observation.referenceRange.normalValue"/>       <short value="Normal value, if relevant"/>       <definition value="The value of the normal value of the reference range."/>       <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.normalValue"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationReferenceRangeNormalValue"/>         </extension>         <strength value="example"/>         <description value="Codes identifying the normal value of the observation."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-referencerange-normalvalue"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value:IVL_PQ.normal"/>       </mapping>     </element>     <element id="Observation.referenceRange.type">      <path value="Observation.referenceRange.type"/>       <short value="Reference range qualifier"/>       <definition value="Codes to indicate the what part of the targeted reference population it applies

       to. For example, the normal or therapeutic range."/> 
      <comment value="This SHOULD be populated if there is more than one range.  If this element is not

       present then the normal range is assumed."/> 
      <requirements value="Need to be able to say what kind of reference range this is - normal, recommended,

       therapeutic, etc.,  - for proper interpretation."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.type"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationRangeMeaning"/>         </extension>         <strength value="preferred"/>         <description value="Code for the meaning of a reference range."/>         <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-10"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="interpretationCode"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>       </mapping>     </element>     <element id="Observation.referenceRange.appliesTo">      <path value="Observation.referenceRange.appliesTo"/>       <short value="Reference range population"/> 
      <definition value="Codes to indicate the target population this reference range applies to.  For example,
       a reference range may be based on the normal population or a particular sex or race.
      This SHOULD be populated if there is more than one range.  If this element is not present
       then the normal population is assumed.
      
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The age at which this reference range is applicable. This is a neonatal age (e.g. number
       of weeks at term) if the meaning says so.
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      Text based reference range in an observation which may be used when a quantitative range
       is not appropriate for an observation.  An example would be a reference value of &quot;Negative&quot
      ; or a list or table of 'normals'.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      For a discussion on the ways Observations can assembled in groups together see [Notes
       below](observation.html#4.20.4).
      Normally, an observation will have either a value or a set of related observations. A
       few observations (e.g. Apgar score) may have both a value and a set of related observations
       or sometimes a QuestionnaireResponse from which the measure is derived.
      
      
      
        
        
        
      
      
        
      
      
        
        
        
        
        
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
    
    
      
      
      
      The &quot;derived-from&quot; type is the only logical choice when referencing the QuestionnaireAnswe
      r resource.
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      A reference to the observation or [QuestionnaireResponse](questionnaireresponse.html#)
       resource that is related to this observation.
      
      
      
        
        
        
      
      
        
        
      
      
      
        
        
      
    
    
      
      
      
      For a discussion on the ways Observations can be assembled in groups together see [Notes](observatio
      n.html#notes) below.
      Component observations share the same attributes in the Observation resource as the primary
       observation and are always treated a part of a single observation (they are not separable).
         However, the reference range for the primary observation value is not inherited by the
       component values and is required when appropriate for each component observation.
      
      
      
        
        
        
      
      
        
      
      
        
        
        
        
        
        
      
      
        
        
        
        
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      

       a reference range may be based on the normal population or a particular sex or
       race.  Multiple `appliesTo`  are interpreted as an &quot;AND&quot; of the target
       populations.  For example, to represent a target population of African American
       females, both a code of female and a code for African American would be used."/> 
      <comment value="This SHOULD be populated if there is more than one range.  If this element is not

       present then the normal population is assumed."/> 
      <requirements value="Need to be able to identify the target population for proper interpretation."/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.referenceRange.appliesTo"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationRangeType"/>         </extension>         <strength value="example"/>         <description value="Codes identifying the population the reference range applies to."/>         <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-10"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="interpretationCode"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>       </mapping>     </element>     <element id="Observation.referenceRange.age">      <path value="Observation.referenceRange.age"/>       <short value="Applicable age range, if relevant"/>       <definition value="The age at which this reference range is applicable. This is a neonatal age (e.g.

       number of weeks at term) if the meaning says so."/> 
      <requirements value="Some analytes vary greatly over age."/>       <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.age"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Range"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>       </mapping>     </element>     <element id="Observation.referenceRange.text">      <path value="Observation.referenceRange.text"/>       <short value="Text based reference range in an observation"/>       <definition value="Text based reference range in an observation which may be used when a quantitative

       range is not appropriate for an observation.  An example would be a reference value
       of &quot;Negative&quot; or a list or table of &quot;normals&quot;."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.referenceRange.text"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="markdown"/>       </type>       <condition value="obs-3"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value:ST"/>       </mapping>     </element>     <element id="Observation.hasMember">      <path value="Observation.hasMember"/>       <short value="Used when reporting observations included in a vital signs panel"/>       <definition value="Used when reporting observations included in a vital signs panel."/>       <comment value="When using this element, an observation will typically have either a value or a

       set of related resources, although both may be present in some cases.  For a discussion
       on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgr
      ouping) below.  Note that a system may calculate results from [QuestionnaireResponse](question
      naireresponse.html)  into a final score and represent the score as an Observation."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.hasMember"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="v2"/>         <map value="Relationships established by OBX-4 usage"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="outBoundRelationship"/>       </mapping>     </element>     <element id="Observation.derivedFrom">      <path value="Observation.derivedFrom"/>       <short value="Related resource from which the observation is made"/>       <definition value="The target resource that represents a measurement from which this observation value

       is derived. For example, a calculated anion gap or a fetal measurement based on
       an ultrasound image."/> 
      <comment value="All the reference choices that are listed in this element can represent clinical

       observations and other measurements that may be the source for a derived value.
        The most common reference will be another Observation.  For a discussion on the
       ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping)
       below."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.derivedFrom"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="v2"/>         <map value="Relationships established by OBX-4 usage"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value=".targetObservation"/>       </mapping>     </element>     <element id="Observation.component">      <path value="Observation.component"/>       <short value="Component results"/>       <definition value="Some observations have multiple component observations.  These component observations

       are expressed as separate code value pairs that share the same attributes.  Examples
       include systolic and diastolic component observations for blood pressure measurement
       and multiple component observations for genetics observations."/> 
      <comment value="For a discussion on the ways Observations can be assembled in groups together see

       [Notes](observation.html#notes) below."/> 
      <requirements value="Component observations share the same attributes in the Observation resource as

       the primary observation and are always treated a part of a single observation (they
       are not separable). However, reference range, dataAbsentReason, and interpretation
       can differ between the components and are not inherited; these should be provided
       if appropriate."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.component"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="BackboneElement"/>       </type>       <condition value="obs-7"/>       <condition value="obs-11"/>       <condition value="obs-10"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children or both"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="v2"/>         <map value="containment by OBX-4?"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="outBoundRelationship[typeCode=COMP]"/>       </mapping>     </element>     <element id="Observation.component.id">      <path value="Observation.component.id"/>       <representation value="xmlAttr"/>       <short value="Unique id for inter-element referencing"/>       <definition value="Unique id for the element within a resource (for internal references). This may

       be any string value that does not contain spaces."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Element.id"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">          <valueUrl value="string"/>         </extension>         <code value="http://hl7.org/fhirpath/System.String"/>       </type>       <condition value="ele-1"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.component.extension">      <path value="Observation.component.extension"/>       <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
    
    
      
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Normally, an observation will have either a single value or a set of related observations.
       A few observations (e.g. Apgar score) may have both a value and related observations (for
       an Apgar score, the observations from which the measure is derived). If a value is present,
       the datatype for this element should be determined by Observation.code. A CodeableConcept
       with just a text would be used instead of a string if the field was usually coded, or
       if the type associated with the Observation.code defines a coded value.   For boolean
       values use valueCodeableConcept and select codes from &lt;http://hl7.org/fhir/ValueSet/v2-0136&gt;
       (these &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot;
       or other mutually exclusive terms that may be needed&quot;).  The element, Observation.value[x],
       has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept,
       valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format
       is &quot;'value' + the type name&quot; with a capital on the first letter of the type).
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      unique id for the element within a resource (for internal references). This may be any
       string value that does not contain spaces.
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
        
          
          
        
        
        
      
      

       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Element.extension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="rim"/>         <map value="n/a"/>       </mapping>     </element>     <element id="Observation.component.modifierExtension">      <path value="Observation.component.modifierExtension"/>       <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension.
      There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone.
      
      
      
      
      
        
        
        
      
      
        
      
      
        
        
      
    
    
      
      
      The value of the measured amount. The value includes an implicit precision in the presentation
       of the value.
      The implicit precision in the value should always be honored. Monetary values have their
       own rules for handling precision (refer to standard accounting text books).
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      How the value should be understood and represented - whether the actual value is greater
       or less than the stated value due to measurement issues; e.g. if the comparator is &quot;&lt;&quot;
       , then the real value is &lt; stated value.
      This is labeled as &quot;Is Modifier&quot; because the comparator modifies the interpretation
       of the value significantly. If there is no comparator, then there is no modification of
       the value.
      Need a framework for handling measures where the value is &lt;5ug/L or &gt;400mg/L due
       to the limitations of measuring methodology.
      
      
      
        
        
        
      
      
        
      
      
      
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
    
    
      
        
      
      
      
      
      There are many representations for units of measure and in many contexts, particular representations
       are fixed and required. I.e. mcg for micrograms.
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      
      
      
      
        
        
        
      
      
        
      
      
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or
       ISO 4217 for currency.  The context of use may additionally require a code from a particular
       system.
      Need a computable form of the unit that is fixed across all forms. UCUM provides this
       for quantities, but SNOMED CT provides many units of interest.
      
      
      
        
        
        
      
      
        
      
      
      
      
        
        
      
      
        
        
      
    
    
      
      
      

       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,

       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be

       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/>       <alias value="user content"/>       <alias value="modifiers"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="BackboneElement.modifierExtension"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="Extension"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <isModifier value="true"/>       <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the

       element that contains them"/> 
      <isSummary value="true"/>       <mapping>         <identity value="rim"/>         <map value="N/A"/>       </mapping>     </element>     <element id="Observation.component.code">      <path value="Observation.component.code"/>       <short value="Vital Sign measurement or component"/>       <definition value="Vital Sign measurement or component."/>       <comment value="*All* code-value and  component.code-component.value pairs need to be taken into

       account to correctly understand the meaning of the observation."/> 
      <requirements value="Knowing what kind of observation is being made is essential to understanding the

       observation."/> 
      <min value="1"/>       <max value="1"/>       <base>         <path value="Observation.component.code"/>         <min value="1"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <condition value="obs-7"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationCode"/>         </extension>         <strength value="example"/>         <description value="Codes identifying names of simple observations."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes-observationorboth"/>       </binding>       <mapping>         <identity value="w5"/>         <map value="FiveWs.what[x]"/>       </mapping>       <mapping>         <identity value="v2"/>         <map value="OBX-3"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="code"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 363787002 |Observable entity| OR 
&lt; 386053000 |Evaluation procedure|"/>       </mapping>     </element>     <element id="Observation.component.value[x]">      <path value="Observation.component.value[x]"/>       <slicing>         <discriminator>           <type value="type"/>           <path value="$this"/>         </discriminator>         <ordered value="false"/>         <rules value="open"/>       </slicing>       <short value="The value for the vital sign component being observed."/>       <definition value="The value for the vital sign component being observed."/>       <comment value="Used when observation has a set of component observations:
-  An observation may have both a value (e.g. an  Apgar score) and component observations
       (the observations from which the Apgar score was derived). 
-  If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- The usage of valueReference is restricted to the MolecularDefinition resources
       as a definitional resource, not as a patient-specific finding. 
- For additional guidance, see the [Notes section](observation.html#notes) below."/> 
      <requirements value="An observation exists to have a value, though it might not if it is in error, or

       if it represents a group of observations."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.component.value[x]"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <type>         <code value="CodeableConcept"/>       </type>       <type>         <code value="string"/>       </type>       <type>         <code value="boolean"/>       </type>       <type>         <code value="integer"/>       </type>       <type>         <code value="Range"/>       </type>       <type>         <code value="Ratio"/>       </type>       <type>         <code value="SampledData"/>       </type>       <type>         <code value="time"/>       </type>       <type>         <code value="dateTime"/>       </type>       <type>         <code value="Period"/>       </type>       <type>         <code value="Attachment"/>       </type>       <type>         <code value="Reference"/>         <targetProfile value="http://hl7.org/fhir/StructureDefinition/MolecularDefinition"/>       </type>       <condition value="obs-10"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <mapping>         <identity value="v2"/>         <map value="OBX-2, OBX-5, OBX-6"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363714003 |Interprets|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>       </mapping>     </element>     <element id="Observation.component.value[x]:valueQuantity">      <path value="Observation.component.value[x]"/>       <sliceName value="valueQuantity"/>       <short value="Vital Sign component value recorded as a component with UCUM (preferred)"/>       <definition value="Vital Sign component value recorded as a component with UCUM (preferred)."/>       <comment value="Used when observation has a set of component observations:
-  An observation may have both a value (e.g. an  Apgar score) and component observations
       (the observations from which the Apgar score was derived). 
-  If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- If a value is present, the datatype for this element should be determined by
       the `code`.
-  *CodeableConcept* with just a text would be used instead of a string if the
       field was usually coded, or if the type associated with the `code` defines a coded
       value.
-  *Attachment* is used if the observation result value is a binary file such as
       an image.  If the observation result value is derived from the binary file (for
       example 'X' detected and here is the the proof in this image), the binary file
       may be directly represented using *DocumentReference* and referenced by `derivedFrom`.
- The usage of valueReference is restricted to the MolecularDefinition resources
       as a definitional resource, not as a patient-specific finding. 
- For additional guidance, see the [Notes section](observation.html#notes) below."/> 
      <requirements value="An observation exists to have a value, though it might not if it is in error, or

       if it represents a group of observations."/> 
      <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.component.value[x]"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="Quantity"/>       </type>       <condition value="obs-10"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="true"/>       <binding>         <extension url="http://hl7.org/fhir/tools/StructureDefinition/binding-definition">          <valueString value="UCUM units"/>         </extension>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="UCUMunits"/>         </extension>         <strength value="preferred"/>         <description value="UCUM units - for recording Vital Signs and components."/>         <valueSet value="http://unitsofmeasure.org/vs"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-2, OBX-5, OBX-6"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363714003 |Interprets|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>       </mapping>     </element>     <element id="Observation.component.dataAbsentReason">      <path value="Observation.component.dataAbsentReason"/>       <short value="Why the component result value is missing"/>       <definition value="Provides a reason why the expected value in the element Observation.component.value[x]

       is missing."/> 

      <comment value="&quot;Null&quot; or exceptional values can be represented two ways in FHIR Observations.
        One way is to simply include them in the value set and represent the exceptions in the
       value.  For example, measurement values for a serology test could be  &quot;detected&quot;,
       &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;.   The
       alternate way is to use the value element for actual observations and use the explicit
       dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason
       code &quot;error&quot; could be used when the measurement was not completed.  Because
       of these options, use-case agreements are required to interpret general observations for
       exceptional values.
      
      
      
      
        
        
        
      
      
        
      
      
      
      
        
          
        
        
        
          
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      The assessment made based on the result of the observation.  Intended as a simple compact
       code often placed adjacent to the result value in reports and flow sheets to signal the
       meaning/normalcy status of the result. Otherwise known as abnormal flag.
      The component interpretation applies only to the individual component value.  For an overall
       interpretation all components together use thes Observation.interpretation element.
      For some results, particularly numeric results, an interpretation is necessary to fully
       understand the significance of a result.
      
      
      
      
        
        
        
      
      
        
      
      
        
          
        
        
        
        
          
        
      
      
        
        
      
      
        
        
      
      
        
        
      
      
        
        
      
    
    
      
      
      
      Most observations only have one generic reference range. Systems MAY choose to restrict
       to only supplying the relevant reference range based on knowledge about the patient (e.g.,
       specific to the patient's age, gender, weight and other factors), but this may not be
       possible or appropriate. Whenever more than one reference range is supplied, the differences
       between them SHOULD be provided in the reference range and/or age properties.

        One way is to simply include them in the value set and represent the exceptions
       in the value.  For example, measurement values for a serology test could be  &quot;detected&q
      uot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;.
       
The alternate way is to use the value element for actual observations and use the
       explicit dataAbsentReason element to record exceptional values.  For example, the
       dataAbsentReason code &quot;error&quot; could be used when the measurement was
       not completed.  Because of these options, use-case agreements are required to interpret
       general observations for exceptional values."/> 
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/>       <min value="0"/>       <max value="1"/>       <base>         <path value="Observation.component.dataAbsentReason"/>         <min value="0"/>         <max value="1"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <condition value="obs-10"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationValueAbsentReason"/>         </extension>         <strength value="extensible"/>         <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/>         <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="N/A"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="value.nullFlavor"/>       </mapping>     </element>     <element id="Observation.component.interpretation">      <path value="Observation.component.interpretation"/>       <short value="High, low, normal, etc"/>       <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/>       <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use

       extends to other use cases where coded interpretations  are relevant.  Often reported
       as one or more simple compact codes this element is often placed adjacent to the
       result value in reports and flow sheets to signal the meaning/normalcy status of
       the result."/> 
      <requirements value="For some results, particularly numeric results, an interpretation is necessary

       to fully understand the significance of a result."/> 
      <alias value="Abnormal Flag"/>       <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.component.interpretation"/>         <min value="0"/>         <max value="*"/>       </base>       <type>         <code value="CodeableConcept"/>       </type>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="ObservationInterpretation"/>         </extension>         <strength value="extensible"/>         <description value="Codes identifying interpretations of observations."/>         <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>       </binding>       <mapping>         <identity value="v2"/>         <map value="OBX-8"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="interpretationCode"/>       </mapping>       <mapping>         <identity value="sct-attr"/>         <map value="363713009 |Has interpretation|"/>       </mapping>       <mapping>         <identity value="sct-concept"/>         <map value="&lt; 260245000 |Findings values|"/>       </mapping>     </element>     <element id="Observation.component.referenceRange">      <path value="Observation.component.referenceRange"/>       <short value="Provides guide for interpretation of component result value"/>       <definition value="Guidance on how to interpret the value by comparison to a normal or recommended

       range."/> 
      <comment value="Most observations only have one generic reference range. Systems MAY choose to

       restrict to only supplying the relevant reference range based on knowledge about
       the patient (e.g., specific to the patient's age, gender, weight and other factors),
       but this might not be possible or appropriate. Whenever more than one reference
       range is supplied, the differences between them SHOULD be provided in the reference
       range and/or age properties."/> 

      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance
       of a particular result. Need to be able to provide multiple reference ranges for different
       contexts.
      
      
      
        
        
        
      
      
      
        
        
      
      
        
        
      
    
  
  
    
      
      
      This profile defines  how to represent Body Mass Index (BMI) observations in FHIR using
       a standard LOINC code and UCUM units of measure.
      
      
    
    
      
      
      
      additional codes that translate or map to this code are allowed.  For example a more granular
       LOINC code or code that is used locally in a system.
      
      
    
    
      
      
        
          
          
        
        
        
      
    
    
      
      
    
    
      
      
        
      
      
    
    
      
      
        
      
      
    
    
      
    
    
      
      
        
      
      
    
  

       of a particular result. Need to be able to provide multiple reference ranges for
       different contexts."/> 
      <min value="0"/>       <max value="*"/>       <base>         <path value="Observation.component.referenceRange"/>         <min value="0"/>         <max value="*"/>       </base>       <contentReference value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange"/>       <constraint>         <key value="ele-1"/>         <severity value="error"/>         <human value="All FHIR elements must have a @value or children"/>         <expression value="hasValue() or (children().count() &gt; id.count())"/>         <source value="http://hl7.org/fhir/StructureDefinition/Element"/>       </constraint>       <mustSupport value="false"/>       <isModifier value="false"/>       <isSummary value="false"/>       <mapping>         <identity value="v2"/>         <map value="OBX-7"/>       </mapping>       <mapping>         <identity value="rim"/>         <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>       </mapping>     </element>   </snapshot>   <differential>     <element id="Observation">      <path value="Observation"/>       <short value="FHIR Body Mass Index (BMI) Profile"/>       <definition value="This profile defines  how to represent Body Mass Index (BMI) observations in FHIR

       using a standard LOINC code and UCUM units of measure."/> 
      <constraint>         <key value="vs-4"/>         <severity value="error"/>         <human value="For single vital signs observations (that do not require use of components or hasMember),

         then either a value[x] or a data absent reason must be present."/> 
        <expression value="dataAbsentReason.exists() or value.exists()"/>       </constraint>     </element>     <element id="Observation.code">      <path value="Observation.code"/>       <short value="Body Mass Index (BMI)"/>       <definition value="Body Mass Index (BMI)"/>       <patternCodeableConcept>         <coding>           <system value="http://loinc.org"/>           <code value="39156-5"/>         </coding>       </patternCodeableConcept>       <mustSupport value="true"/>       <binding>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="VitalSignsBMI"/>         </extension>         <strength value="preferred"/>         <description value="This identifies the set of LOINC codes that are appropriate for representing body

         mass index (BMI) vital sign measurements in Observation.code."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsign-bmi"/>       </binding>     </element>     <element id="Observation.valueQuantity">      <path value="Observation.valueQuantity"/>       <condition value="vsp-4"/>       <mustSupport value="true"/>       <binding>         <extension url="http://hl7.org/fhir/tools/StructureDefinition/binding-definition">          <valueString value="Common UCUM units for BMI."/>         </extension>         <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">          <valueString value="BMIUnits"/>         </extension>         <strength value="required"/>         <description value="kg/m2"/>         <valueSet value="http://hl7.org/fhir/ValueSet/ucum-bmi"/>       </binding>     </element>     <element id="Observation.dataAbsentReason">      <path value="Observation.dataAbsentReason"/>       <condition value="vsp-4"/>       <mustSupport value="true"/>     </element>   </differential> 


</

StructureDefinition

>