This structure is derived from Observation .

Summary

10.1.19.2.2 10.1.18.5.2 Complete Summary of the Mandatory Requirements

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

   • ObservationStatus value set.

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

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

3. A code in Observation.code

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

4. One patient in Observation.subject

5. A date and time in effectiveDateTime

6. Either one Observation.value[x] or a populated component (with component.code and either component.value[x] or component.dataAbsentReason ) or hasMember relationship. If there are none of those, then one code in Observation.DataAbsentReason

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

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

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

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

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

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

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

Mandatory: 5 elements
Must-Support: 6 elements

Slices

This structure defines the following Slices :

• The element Observation.category is sliced based on the value of pattern:$this
The element Observation.component.value[x] is sliced based on the value of type:$this (Closed)

This indicates the differences between this profile and the base Observation structure.

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0 .. *	Observation	FHIR Vital Signs Base Profile vsp-1: Constraints: if Observation.effective[x] (as dateTime) has a value then that value shall be precise at least to the day vsp-2: vsp-1 If there is no component or hasMember element then either a value[x] or a data absent reason must be present. , vsp-2
status	S	1 .. 1	code	registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: Vital Signs Category ( preferred ) : This value set includes the required vital sign interoperability categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex) (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
code	S	1.. 1	CodeableConcept	Vital Sign Measurement Binding: Vital Signs Measurement ( preferred ): ) : This identifies the vital sign measurement.
subject	S	1.. 1	Reference ( Patient )	Who and/or what the observation is about
effective[x]	S C	1.. 1	dateTime	Vital Signs are point in time measurements and are recorded using the dateTime data type
value[x]	C	0 .. 1	Quantity	The quantity for the Quantity data type. For supporting component observations recorded as a component, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. vital sign being observed. Binding: Vital Signs Units ( preferred ): ) : Commonly encountered UCUM units for recording Vital Signs.
dataAbsentReason	C	0 .. 1	CodeableConcept	Why the result value is missing
hasMember		0 .. *	Reference ( Observation )	Used when reporting observations included in a vital signs panel
derivedFrom		0 .. *	Reference ( DocumentReference | Observation )	Related resource from which the observation is made
component		0 .. *	BackboneElement	Component results
code		1 .. 1	CodeableConcept	Vital Sign measurement or component
Slices for value[x]		0 .. .. 1	Quantity , , CodeableConcept , , string , , boolean , , integer , , Range , , Ratio , , SampledData , , time , , dateTime , , Period , , Attachment , , Reference ()	The value for the vital sign component being observed.
) Vital Signs values are recorded using the Quantity data type. For supporting component observations, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. Slices for value[x] Slice:	Unordered, Closed by type:$this			Content/Rules for all slices
value[x]:valueQuantity		0 .. 1	Quantity	Vital Sign component value recorded as a component with UCUM (preferred) Binding: UCUM units - for recording Vital Signs and components. ( preferred ): ) : UCUM units - for recording Vital Signs and components.
dataAbsentReason		0 .. 1	CodeableConcept	Why the component result value is missing
Documentation for this format

This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Observation structure.

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	FHIR Vital Signs Base Profile obs-6: Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: 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). obs-8: Constraints: bodyStructure SHALL only be present if Observation.bodySite is not present obs-10: vsp-1 Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x] is not present obs-11: , if organizer exists and organizer = true, then value[x], dataAbsentReason and component SHALL NOT be present vsp-1: vsp-2 if Observation.effective[x] (as dateTime) has a value then that value shall be precise at least to the day vsp-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?! Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: All Languages ( required ): ) : IETF language tag for a human language Additional Bindings Purpose Common Languages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
instantiates[x] Σ 0..1 canonical ( ObservationDefinition ), Reference ( ObservationDefinition ) Instantiates FHIR ObservationDefinition basedOn	Σ	0..*	Reference ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest )	Fulfills plan, proposal or order
triggeredBy		0..*	BackboneElement	Triggering observation(s)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ	1..1	code	reflex | repeat | re-run Binding: triggered Bytype ( required ): ) : The type of TriggeredBy Observation.
reason		0..1	string	Reason that the observation was triggered
partOf	Σ	0..*	Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy )	Part of referenced event
status	?! S Σ	1..1	code	registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained Binding: Observation Status ( required ): ) : Codes providing the status of an observation.
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: Vital Signs Observation Category Codes ( preferred ) : : This value set includes the required vital sign interoperability Codes for high level observation categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes ( preferred ): ) : Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex) (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S Σ C	1..1	CodeableConcept	Vital Sign Measurement Binding: Vital Signs Measurement ( preferred ): ) : This identifies the vital sign measurement.
subject	S Σ	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	?! Σ	0..*	Reference ( Resource )	What the observation is about, when it is not about the subject of record
organizer	Σ C	0..1	boolean	This observation organizes/groups a set of sub-observations
encounter	Σ	0..1	Reference ( Encounter )	Healthcare event during which this observation is made made. If you need to place the observation within one or more episodes of care, use the workflow-episodeOfCare extension
effective[x]	S Σ C	1..1	dateTime	Vital Signs are point in time measurements and are recorded using the dateTime data type
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson | HealthcareService | Group )	Who is responsible for the observation
value[x]	Σ C	0..1	Quantity	The quantity for the Quantity data type. For supporting component observations recorded as a component, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. vital sign being observed. Binding: Vital Signs Units ( preferred ): ) : Commonly encountered UCUM units for recording Vital Signs.
dataAbsentReason	C	0..1	CodeableConcept	Why the result value is missing Binding: Data Absent Reason ( extensible ): ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc Binding: Observation Interpretation Codes ( extensible ): ) : Codes identifying interpretations of observations.
interpretationContext		0..*	CodeableReference ( Resource )	Context for understanding the observation Binding: Observation Interpretation Context Codes ( example ) : Codes identifying contextual factors that affect interpretation of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	DEPRECATED: Observed body part Binding: SNOMED CT Body Structures ( example ): ) : SNOMED CT Body site concepts
bodyStructure		0..1	Reference CodeableReference ( BodyStructure )	Observed body structure Binding: SNOMED CT Body Structures ( example ) : SNOMED CT Body Structures
method		0..1	CodeableConcept	How it was done Binding: Observation Methods ( example ): ) : Methods for simple observations.
specimen	C	0..1	Reference ( Specimen | Group )	Specimen used for this observation obs-9: If Observation.specimen is a reference to Group, the group can only have specimens
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity Quantity	Low Range, if relevant
high	C	0..1	SimpleQuantity Quantity	High Range, if relevant
normalValue		0..1	CodeableConcept	Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( extensible example ): ) : Codes identifying the normal value of the observation.
type		0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes ( preferred ): ) : Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes ( example ): ) : Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text	C	0..1	markdown	Text based reference range in an observation
hasMember	Σ	0..*	Reference ( Observation )	Used when reporting observations included in a vital signs panel
derivedFrom	Σ	0..*	Reference ( DocumentReference | Observation )	Related resource from which the observation is made
component	Σ C	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ C	1..1	CodeableConcept	Vital Sign measurement or component Binding: LOINC Codes codes with Observation or Both ( example ): ) : Codes identifying names of simple observations.
Slices for value[x]	Σ C	0 .. 1		Vital Signs values are recorded using The value for the Quantity data type. For supporting vital sign component observations, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. being observed. Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence ) (Any)
value[x]:valueQuantity	Σ C	0..1	Quantity	Vital Sign component value recorded as a component with UCUM (preferred) Binding: UCUM units - for recording Vital Signs and components. ( preferred ): ) : UCUM units - for recording Vital Signs and components.
dataAbsentReason	C	0..1	CodeableConcept	Why the component result value is missing Binding: Data Absent Reason ( extensible ): ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc Binding: Observation Interpretation Codes ( extensible ): ) : Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result value
Documentation for this format

<!-- Observationvitalsignsbase -->

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- I 0..1 Meta Metadata about the resource --></meta>
 <

 <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created -->

 <language value="[code]"/><!-- I 0..1 Language of the resource content   -->
 <text><!-- I 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <<a href="vitalsigns-definitions.html#Observation.modifierExtension" title="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 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.


 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 
     Business Identifier for observation --></identifier>
 <
     Instantiates FHIR ObservationDefinition</instantiates[x]>

 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <<a href="vitalsigns-definitions.html#Observation.triggeredBy.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <<a href="vitalsigns-definitions.html#Observation.triggeredBy.type" title="The type of trigger.

  <type value="[code]"/><!-- I 1..1 reflex | repeat | re-run   -->
  <reason value="[string]"/><!-- I 0..1 Reason that the observation was triggered -->
 </triggeredBy>
 <partOf><!-- I 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- I 1..1 registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained   -->
 <-- category sliced by pattern:$this  in the specified orderOpen-->
 <</category>

 <category><!-- I 1..1 CodeableConcept Classification of  type of observation   --></category>

 <code><!-- I 1..1 CodeableConcept Vital Sign Measurement   --></code>
 <subject><!-- I 1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <<a href="vitalsigns-definitions.html#Observation.focus" title="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) (this element modifies the meaning of other elements)" class="dict">

 <focus><!-- I 0..* Reference(Resource) 

     What the observation is about, when it is not about the subject of record --></focus>
 <organizer value="[boolean]"/><!-- I 0..1 This observation organizes/groups a set of sub-observations -->
 <encounter><!-- I 0..1 Reference(Encounter) 
     Healthcare event during which this observation is made</encounter>

     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 --></encounter>

 <effectiveDateTime value="[dateTime]"/><!-- I 1..1 
     Vital Signs are point in time measurements and are recorded using the dateTime data type -->
 <issued value="[instant]"/><!-- I 0..1 Date/Time this version was made available -->
 <performer><!-- I 0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <</valueQuantity>

 <valueQuantity><!-- I 0..1 Quantity The quantity for the vital sign being observed.   --></valueQuantity>

 <dataAbsentReason><!-- I 0..1 CodeableConcept Why the result value is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <interpretationContext><!-- I 0..* CodeableReference Context for understanding the observation   --></interpretationContext>

 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <</bodySite>
 <</bodyStructure>

 <bodySite><!-- I 0..1 CodeableConcept DEPRECATED: Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 CodeableReference Observed body structure   --></bodyStructure>

 <method><!-- I 0..1 CodeableConcept How it was done   --></method>
 <specimen><!-- I 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- I 0..1 Reference(Device) 
     A reference to the device that generates the measurements or the device settings for the device --></device>
 <referenceRange> I 0..* BackboneElement  <!-- I 0..* Provides guide for interpretation -->
  <<a href="vitalsigns-definitions.html#Observation.referenceRange.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <

  <low><!-- I 0..1 Quantity 

      Low Range, if relevant --></low>
  <

  <high><!-- I 0..1 Quantity 

      High Range, if relevant --></high>
  <normalValue><!-- I 0..1 CodeableConcept Normal value, if relevant   --></normalValue>
  <type><!-- I 0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!-- I 0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!-- I 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[markdown]"/><!-- I 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- I 0..* Reference(Observation) 
     Used when reporting observations included in a vital signs panel --></hasMember>
 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Component results -->
  <<a href="vitalsigns-definitions.html#Observation.component.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <</code>

  <code><!-- I 1..1 CodeableConcept Vital Sign measurement or component   --></code>

  <-- value[x] sliced by type:$this  in the specified orderOpen-->
  <valueQuantity><!-- I 0..1 Quantity Vital Sign component value recorded as a component with UCUM (preferred)    --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result value is missing   --></dataAbsentReason>
  <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result value --></referenceRange>
 </component>
</Observation>

{ // Observationvitalsignsbase
  // from Element: extension
    "meta" : { Meta }, // IMetadata about the resource
    "

    "implicitRules" : "<uri>", // IA set of rules under which this content was created

    "language" : "<code>", // ILanguage of the resource content
    "text" : { Narrative }, // IText summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "<a href="vitalsigns-definitions.html#Observation.modifierExtension" title="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 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.


    "modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation

    "
    "

    "basedOn" : [{ Reference(CarePlan) }], // IFulfills plan, proposal or order
    "triggeredBy" : [{ BackboneElement }], // ITriggering observation(s)
    "partOf" : [{ Reference(MedicationAdministration) }], // IPart of referenced event
    "status" : "<code>", // I R! registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
    "category" : [ //  sliced by pattern:$this  in the specified order, Open 
      { // Classification of  type of observation // I R! 
        // from Element: extension
      }
    ],
    "code" : { CodeableConcept }, // I R! Vital Sign Measurement
    "subject" : { Reference(Patient) }, // I R! Who and/or what the observation is about
    "<a href="vitalsigns-definitions.html#Observation.focus" title="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) (this element modifies the meaning of other elements)" class="dict">

    "focus" : [{ Reference(Resource) }], // IWhat the observation is about, when it is not about the subject of record

    "organizer" : <boolean>, // IThis observation organizes/groups a set of sub-observations
    "

    "encounter" : { Reference(Encounter) }, // IHealthcare 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

    "effectiveDateTime" : "<dateTime>", // I R! Vital Signs are point in time measurements and are recorded using the dateTime data type
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
    "

    "valueQuantity" : { Quantity }, // IThe quantity for the vital sign being observed.

    "dataAbsentReason" : { CodeableConcept }, // IWhy the result value is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "interpretationContext" : [{ CodeableReference(Resource) }], // IContext for understanding the observation

    "note" : [{ Annotation }], // IComments about the observation
    "
    "

    "bodySite" : { CodeableConcept }, // IDEPRECATED: Observed body part
    "bodyStructure" : { CodeableReference(BodyStructure) }, // IObserved body structure

    "method" : { CodeableConcept }, // IHow it was done
    "specimen" : { Reference(Specimen) }, // ISpecimen used for this observation
    "device" : { Reference(Device) }, // IA reference to the device that generates the measurements or the device settings for the device
    "referenceRange" : [{ BackboneElement }], // IProvides guide for interpretation
    "hasMember" : [{ Reference(Observation) }], // IUsed when reporting observations included in a vital signs panel
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IComponent results
  }

Summary

10.1.19.2.3 10.1.18.5.3 Complete Summary of the Mandatory Requirements

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

   • ObservationStatus value set.

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

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

3. A code in Observation.code

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

4. One patient in Observation.subject

5. A date and time in effectiveDateTime

6. Either one Observation.value[x] or a populated component (with component.code and either component.value[x] or component.dataAbsentReason ) or hasMember relationship. If there are none of those, then one code in Observation.DataAbsentReason

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

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

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

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

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

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

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

Mandatory: 5 elements
Must-Support: 6 elements

Slices

This structure defines the following Slices :

• The element Observation.category is sliced based on the value of pattern:$this
The element Observation.component.value[x] is sliced based on the value of type:$this (Closed)

This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Observation structure.

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	FHIR Vital Signs Base Profile obs-6: Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: 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). obs-8: Constraints: bodyStructure SHALL only be present if Observation.bodySite is not present obs-10: vsp-1 Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x] is not present obs-11: , if organizer exists and organizer = true, then value[x], dataAbsentReason and component SHALL NOT be present vsp-1: vsp-2 if Observation.effective[x] (as dateTime) has a value then that value shall be precise at least to the day vsp-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?! Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: All Languages ( required ): ) : IETF language tag for a human language Additional Bindings Purpose Common Languages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
instantiates[x] Σ 0..1 canonical ( ObservationDefinition ), Reference ( ObservationDefinition ) Instantiates FHIR ObservationDefinition basedOn	Σ	0..*	Reference ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest )	Fulfills plan, proposal or order
triggeredBy		0..*	BackboneElement	Triggering observation(s)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ	1..1	code	reflex | repeat | re-run Binding: triggered Bytype ( required ): ) : The type of TriggeredBy Observation.
reason		0..1	string	Reason that the observation was triggered
partOf	Σ	0..*	Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy )	Part of referenced event
status	?! S Σ	1..1	code	registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained Binding: Observation Status ( required ): ) : Codes providing the status of an observation.
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: Vital Signs Observation Category Codes ( preferred ) : : This value set includes the required vital sign interoperability Codes for high level observation categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes ( preferred ): ) : Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex) (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S Σ C	1..1	CodeableConcept	Vital Sign Measurement Binding: Vital Signs Measurement ( preferred ): ) : This identifies the vital sign measurement.
subject	S Σ	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	?! Σ	0..*	Reference ( Resource )	What the observation is about, when it is not about the subject of record
organizer	Σ C	0..1	boolean	This observation organizes/groups a set of sub-observations
encounter	Σ	0..1	Reference ( Encounter )	Healthcare event during which this observation is made made. If you need to place the observation within one or more episodes of care, use the workflow-episodeOfCare extension
effective[x]	S Σ C	1..1	dateTime	Vital Signs are point in time measurements and are recorded using the dateTime data type
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson | HealthcareService | Group )	Who is responsible for the observation
value[x]	Σ C	0..1	Quantity	The quantity for the Quantity data type. For supporting component observations recorded as a component, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. vital sign being observed. Binding: Vital Signs Units ( preferred ): ) : Commonly encountered UCUM units for recording Vital Signs.
dataAbsentReason	C	0..1	CodeableConcept	Why the result value is missing Binding: Data Absent Reason ( extensible ): ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc Binding: Observation Interpretation Codes ( extensible ): ) : Codes identifying interpretations of observations.
interpretationContext		0..*	CodeableReference ( Resource )	Context for understanding the observation Binding: Observation Interpretation Context Codes ( example ) : Codes identifying contextual factors that affect interpretation of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	DEPRECATED: Observed body part Binding: SNOMED CT Body Structures ( example ): ) : SNOMED CT Body site concepts
bodyStructure		0..1	Reference CodeableReference ( BodyStructure )	Observed body structure Binding: SNOMED CT Body Structures ( example ) : SNOMED CT Body Structures
method		0..1	CodeableConcept	How it was done Binding: Observation Methods ( example ): ) : Methods for simple observations.
specimen	C	0..1	Reference ( Specimen | Group )	Specimen used for this observation obs-9: If Observation.specimen is a reference to Group, the group can only have specimens
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity Quantity	Low Range, if relevant
high	C	0..1	SimpleQuantity Quantity	High Range, if relevant
normalValue		0..1	CodeableConcept	Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( extensible example ): ) : Codes identifying the normal value of the observation.
type		0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes ( preferred ): ) : Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes ( example ): ) : Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text	C	0..1	markdown	Text based reference range in an observation
hasMember	Σ	0..*	Reference ( Observation )	Used when reporting observations included in a vital signs panel
derivedFrom	Σ	0..*	Reference ( DocumentReference | Observation )	Related resource from which the observation is made
component	Σ C	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ C	1..1	CodeableConcept	Vital Sign measurement or component Binding: LOINC Codes codes with Observation or Both ( example ): ) : Codes identifying names of simple observations.
Slices for value[x]	Σ C	0 .. 1		Vital Signs values are recorded using The value for the Quantity data type. For supporting vital sign component observations, such as blood pressure cuff size, other datatypes such as CodeableConcept could be used. being observed. Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence ) (Any)
value[x]:valueQuantity	Σ C	0..1	Quantity	Vital Sign component value recorded as a component with UCUM (preferred) Binding: UCUM units - for recording Vital Signs and components. ( preferred ): ) : UCUM units - for recording Vital Signs and components.
dataAbsentReason	C	0..1	CodeableConcept	Why the component result value is missing Binding: Data Absent Reason ( extensible ): ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc Binding: Observation Interpretation Codes ( extensible ): ) : Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result value
Documentation for this format

<!-- Observationvitalsignsbase -->

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- I 0..1 Meta Metadata about the resource --></meta>
 <

 <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created -->

 <language value="[code]"/><!-- I 0..1 Language of the resource content   -->
 <text><!-- I 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <<a href="vitalsigns-definitions.html#Observation.modifierExtension" title="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 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.


 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 
     Business Identifier for observation --></identifier>
 <
     Instantiates FHIR ObservationDefinition</instantiates[x]>

 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <<a href="vitalsigns-definitions.html#Observation.triggeredBy.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <<a href="vitalsigns-definitions.html#Observation.triggeredBy.type" title="The type of trigger.

  <type value="[code]"/><!-- I 1..1 reflex | repeat | re-run   -->
  <reason value="[string]"/><!-- I 0..1 Reason that the observation was triggered -->
 </triggeredBy>
 <partOf><!-- I 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- I 1..1 registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained   -->
 <-- category sliced by pattern:$this  in the specified orderOpen-->
 <</category>

 <category><!-- I 1..1 CodeableConcept Classification of  type of observation   --></category>

 <code><!-- I 1..1 CodeableConcept Vital Sign Measurement   --></code>
 <subject><!-- I 1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <<a href="vitalsigns-definitions.html#Observation.focus" title="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) (this element modifies the meaning of other elements)" class="dict">

 <focus><!-- I 0..* Reference(Resource) 

     What the observation is about, when it is not about the subject of record --></focus>
 <organizer value="[boolean]"/><!-- I 0..1 This observation organizes/groups a set of sub-observations -->
 <encounter><!-- I 0..1 Reference(Encounter) 
     Healthcare event during which this observation is made</encounter>

     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 --></encounter>

 <effectiveDateTime value="[dateTime]"/><!-- I 1..1 
     Vital Signs are point in time measurements and are recorded using the dateTime data type -->
 <issued value="[instant]"/><!-- I 0..1 Date/Time this version was made available -->
 <performer><!-- I 0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <</valueQuantity>

 <valueQuantity><!-- I 0..1 Quantity The quantity for the vital sign being observed.   --></valueQuantity>

 <dataAbsentReason><!-- I 0..1 CodeableConcept Why the result value is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <interpretationContext><!-- I 0..* CodeableReference Context for understanding the observation   --></interpretationContext>

 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <</bodySite>
 <</bodyStructure>

 <bodySite><!-- I 0..1 CodeableConcept DEPRECATED: Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 CodeableReference Observed body structure   --></bodyStructure>

 <method><!-- I 0..1 CodeableConcept How it was done   --></method>
 <specimen><!-- I 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- I 0..1 Reference(Device) 
     A reference to the device that generates the measurements or the device settings for the device --></device>
 <referenceRange> I 0..* BackboneElement  <!-- I 0..* Provides guide for interpretation -->
  <<a href="vitalsigns-definitions.html#Observation.referenceRange.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <

  <low><!-- I 0..1 Quantity 

      Low Range, if relevant --></low>
  <

  <high><!-- I 0..1 Quantity 

      High Range, if relevant --></high>
  <normalValue><!-- I 0..1 CodeableConcept Normal value, if relevant   --></normalValue>
  <type><!-- I 0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!-- I 0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!-- I 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[markdown]"/><!-- I 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- I 0..* Reference(Observation) 
     Used when reporting observations included in a vital signs panel --></hasMember>
 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Component results -->
  <<a href="vitalsigns-definitions.html#Observation.component.modifierExtension" title="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 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.


  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <</code>

  <code><!-- I 1..1 CodeableConcept Vital Sign measurement or component   --></code>

  <-- value[x] sliced by type:$this  in the specified orderOpen-->
  <valueQuantity><!-- I 0..1 Quantity Vital Sign component value recorded as a component with UCUM (preferred)    --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result value is missing   --></dataAbsentReason>
  <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result value --></referenceRange>
 </component>
</Observation>

{ // Observationvitalsignsbase
  // from Element: extension
    "meta" : { Meta }, // IMetadata about the resource
    "

    "implicitRules" : "<uri>", // IA set of rules under which this content was created

    "language" : "<code>", // ILanguage of the resource content
    "text" : { Narrative }, // IText summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "<a href="vitalsigns-definitions.html#Observation.modifierExtension" title="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 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.


    "modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation

    "
    "

    "basedOn" : [{ Reference(CarePlan) }], // IFulfills plan, proposal or order
    "triggeredBy" : [{ BackboneElement }], // ITriggering observation(s)
    "partOf" : [{ Reference(MedicationAdministration) }], // IPart of referenced event
    "status" : "<code>", // I R! registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
    "category" : [ //  sliced by pattern:$this  in the specified order, Open 
      { // Classification of  type of observation // I R! 
        // from Element: extension
      }
    ],
    "code" : { CodeableConcept }, // I R! Vital Sign Measurement
    "subject" : { Reference(Patient) }, // I R! Who and/or what the observation is about
    "<a href="vitalsigns-definitions.html#Observation.focus" title="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) (this element modifies the meaning of other elements)" class="dict">

    "focus" : [{ Reference(Resource) }], // IWhat the observation is about, when it is not about the subject of record

    "organizer" : <boolean>, // IThis observation organizes/groups a set of sub-observations
    "

    "encounter" : { Reference(Encounter) }, // IHealthcare 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

    "effectiveDateTime" : "<dateTime>", // I R! Vital Signs are point in time measurements and are recorded using the dateTime data type
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
    "

    "valueQuantity" : { Quantity }, // IThe quantity for the vital sign being observed.

    "dataAbsentReason" : { CodeableConcept }, // IWhy the result value is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "interpretationContext" : [{ CodeableReference(Resource) }], // IContext for understanding the observation

    "note" : [{ Annotation }], // IComments about the observation
    "
    "

    "bodySite" : { CodeableConcept }, // IDEPRECATED: Observed body part
    "bodyStructure" : { CodeableReference(BodyStructure) }, // IObserved body structure

    "method" : { CodeableConcept }, // IHow it was done
    "specimen" : { Reference(Specimen) }, // ISpecimen used for this observation
    "device" : { Reference(Device) }, // IA reference to the device that generates the measurements or the device settings for the device
    "referenceRange" : [{ BackboneElement }], // IProvides guide for interpretation
    "hasMember" : [{ Reference(Observation) }], // IUsed when reporting observations included in a vital signs panel
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IComponent results
  }