This structure is derived from Observation .

Summary

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 or effectivePeriod

6. Either one Observation.value[x] or, if or a populated component (with component.code and either component.value[x] or component.dataAbsentReason ) or hasMember relationship. If there is no value, 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 an 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: 9 5 elements (+1 nested mandatory element)
Must-Support: 15 elements Fixed Value: 2 6 elements

Slices

This structure defines the following Slices :

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

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

Name	Flags	Card.	Type	Description & Constraints
Observation	C I	0..* 0 .. *	Observation	FHIR Vital Signs Base Profile vs-2: Constraints: vsp-1 , vsp-2 If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
status	S	1..1 1 .. 1	code	Binding: registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained ObservationStatus ( required )
Slices for category	S	1 (Slice Definition) .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system pattern:$this
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)
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 1..1	CodeableConcept	Vital Sign Results Measurement Binding: Vital Signs Measurement ( extensible preferred ) : This identifies the vital sign measurement.
subject	S	1.. 1 1..1	Reference ( Patient )	Who and/or what the observation is about
effective[x]	S I 1..1 C Often just a dateTime for Vital Signs vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day	1.. 1	dateTime	Vital Signs are point in time measurements and are recorded using the dateTime data type
value[x]	S I C 0..1	Quantity , 0 CodeableConcept , .. string , 1 boolean ,	integer Quantity , Range	The quantity for the vital sign being observed. , Binding: Ratio Vital Signs Units , ( SampledData preferred , ) time , : dateTime , Commonly encountered UCUM units for recording Vital Signs. Period Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
dataAbsentReason	C S	0 I .. 1 0..1	CodeableConcept	Why the result value is missing
hasMember		0 .. *	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Used when reporting observations included in a vital signs panel components
derivedFrom		0 .. *	Reference ( DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Related resource from which the observation is made
component		0 .. *	BackboneElement	Used when reporting systolic and diastolic blood pressure. vs-3: Component results If there is no a value a data absent reason must be present
code		S 1 .. 1..1 1	CodeableConcept	Vital Signs ( extensible ) Sign measurement or component
value[x]		S 0 I .. 1 0..1	Quantity , , CodeableConcept , , string , , boolean , , integer , , Range , , Ratio , , SampledData , , time , , dateTime , , Period , Attachment , Reference ()	The value for the vital sign component being observed.
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity		0 .. 1	Quantity	Vital Sign Value component value recorded as a component with UCUM (preferred) Binding: UCUM units - for recording Vital Signs Units and components. ( required preferred ) : UCUM units - for recording Vital Signs and components.
dataAbsentReason		S 0 I .. 1 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 I	0..*	Observation	FHIR Vital Signs Base Profile vs-2: Constraints: If there is no component or hasMember element then either a value[x] or a data absent reason must be present. vsp-1 , vsp-2
id	Σ	0..1	string id	Logical id of this artifact
meta	Σ I	0..1	Meta	Metadata about the resource
implicitRules	?! Σ I	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common All Languages ( preferred required ) Max Binding: : All 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	?! I Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ I	0..*	Identifier	Business Identifier for observation
basedOn	Σ I	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
partOf observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ I	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 )	Part of referenced event
status	?! S Σ I	1..1	code	registered | specimen-in-process | preliminary | final | amended + | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained Binding: ObservationStatus Observation Status ( required ) : Codes providing the status of an observation.
Slices for category	S I	1 .. *	(Slice Definition) CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system pattern:$this Binding: Observation Category Codes ( preferred ) : Codes for high level observation categories.
category:VSCat	S I	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 Slice: Unordered, Open by value:url
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system		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 I C	1..1	CodeableConcept	Vital Sign Results Measurement Binding: Vital Signs Measurement ( extensible preferred ) : This identifies the vital sign measurement.
subject	S Σ I	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	?! Σ I	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 I	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 I C	1..1	dateTime	Vital Signs vs-1: if Observation.effective[x] is dateTime are point in time measurements and has a value then that value shall be precise to are recorded using the day effectiveDateTime dateTime effectivePeriod Period data type
issued	Σ I	0..1	instant	Date/Time this version was made available
performer	Σ I	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson | HealthcareService | Group )	Who is responsible for the observation
value[x]	Σ I C	0..1	Quantity	The quantity for the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. vital sign being observed. valueQuantity Binding: Vital Signs Units ( Quantity preferred ) : Commonly encountered UCUM units for recording Vital Signs.
valueCodeableConcept dataAbsentReason	C	0..1	CodeableConcept	Why the result value is missing valueString Binding: string Data Absent Reason valueBoolean ( boolean extensible valueInteger ) : integer Codes specifying why the result ( Observation.value[x] ) is missing.
valueRange Range interpretation valueRatio		0..*	Ratio CodeableConcept	High, low, normal, etc valueSampledData Binding: SampledData Observation Interpretation Codes valueTime ( extensible ) time : Codes identifying interpretations of observations.
valueDateTime interpretationContext		0..*	CodeableReference ( Resource )	Context for understanding the observation valuePeriod Binding: Observation Interpretation Context Codes ( example ) Period : Codes identifying contextual factors that affect interpretation of observations.
dataAbsentReason note		0..*	CodeableConcept Annotation	Comments about the result is missing observation Binding: DataAbsentReason ( extensible )
interpretation bodySite		0..1	CodeableConcept	DEPRECATED: Observed body part High, low, normal, etc. Binding: Observation Interpretation Codes ( extensible SNOMED CT Body Structures ) note ( example I ) 0..* Annotation : Comments about the observation SNOMED CT Body site concepts
bodySite bodyStructure		0..1	CodeableConcept CodeableReference ( BodyStructure )	Observed body part 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 I	0..1	Reference ( Specimen | Group )	Specimen used for this observation
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	C I	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 I	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C I	0..1	SimpleQuantity Quantity	Low Range, if relevant
high	C I	0..1	SimpleQuantity Quantity	High Range, if relevant
type normalValue		0..1	I CodeableConcept	Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( 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 I	0..1	string markdown	Text based reference range in an observation
hasMember	Σ I	0..*	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Used when reporting observations included in a vital signs panel components
derivedFrom	Σ I	0..*	Reference ( DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Related measurements resource from which the observation is made from
component	Σ I 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 I	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ I C	1..1	CodeableConcept	Vital Sign measurement or component observation (code / type) Binding: Vital Signs LOINC codes with Observation or Both ( extensible example ) : Codes identifying names of simple observations.
Slices for value[x]	Σ C	S Σ 0 I .. 1	0..1	The value for the vital sign component being observed. Vital Sign Value recorded with UCUM Slice: Binding: Unordered, Open by type:$this Vital Signs Units ( required )
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 (Any)
dataAbsentReason value[x]:valueQuantity	Σ S C	0..1	Quantity	Vital Sign component value recorded as a component with UCUM (preferred) Binding: I 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: DataAbsentReason Data Absent Reason ( extensible ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. 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

<!-- observation-vitalsigns -->

<!-- Observationvitalsignsbase -->


< xmlns="http://hl7.org/fhir"

<Observation xmlns="http://hl7.org/fhir"

>
  <!-- from Element: extension -->
 <</id>
 <</meta>
 <
 <
 <

 <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>
 <<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 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
 <

 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 

     Business Identifier for observation --></identifier>
 <</basedOn>
 <</partOf>
 <
 
 <
  <
   <
   <
   <
   <
   <
  </coding>
  <
 </category>
 <</code>
 <

 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <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><!-- 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>
 <

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

     What the observation is about, when it is not about the subject of record --></focus>
 <
     Healthcare event during which this observation is made</encounter>
 <
     Often just a dateTime for Vital Signs</effective[x]>
 <
 <

 <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. 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>
 <|
   
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.</value[x]>
 <</dataAbsentReason>
 <</interpretation>
 <</note>
 <</bodySite>
 <</method>
 <</specimen>
 <</device>
 <
  <<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 manageable, 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) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
  <

 <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><!-- 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 -->
  <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>
  <</type>
  <</appliesTo>
  <

  <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>
 <
     Used when reporting vital signs panel components</hasMember>
 <
     Related measurements the observation is made from</derivedFrom>
 <
  <<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 manageable, 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) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
  <</code>
  <|
    </value[x]>
  <</dataAbsentReason>
  <</interpretation>
  <</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 -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <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
    "
    "
    "
    "
    "
    "<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 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">
    "
    "
    "
    "
    " 
      { //  

    "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
    "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
    "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

10.1.18.5.3 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 or effectivePeriod

6. Either one Observation.value[x] or, if or a populated component (with component.code and either component.value[x] or component.dataAbsentReason ) or hasMember relationship. If there is no value, 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 an 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: 9 5 elements (+1 nested mandatory element)
Must-Support: 15 elements Fixed Value: 2 6 elements

Slices

This structure defines the following Slices :

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

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 I	0..*	Observation	FHIR Vital Signs Base Profile vs-2: Constraints: If there is no component or hasMember element then either a value[x] or a data absent reason must be present. vsp-1 , vsp-2
id	Σ	0..1	string id	Logical id of this artifact
meta	Σ I	0..1	Meta	Metadata about the resource
implicitRules	?! Σ I	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common All Languages ( preferred required ) Max Binding: : All 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	?! I Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ I	0..*	Identifier	Business Identifier for observation
basedOn	Σ I	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
partOf observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ I	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 )	Part of referenced event
status	?! S Σ I	1..1	code	registered | specimen-in-process | preliminary | final | amended + | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained Binding: ObservationStatus Observation Status ( required ) : Codes providing the status of an observation.
Slices for category	S I	1 .. *	(Slice Definition) CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system pattern:$this Binding: Observation Category Codes ( preferred ) : Codes for high level observation categories.
category:VSCat	S I	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 Slice: Unordered, Open by value:url
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system		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 I C	1..1	CodeableConcept	Vital Sign Results Measurement Binding: Vital Signs Measurement ( extensible preferred ) : This identifies the vital sign measurement.
subject	S Σ I	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	?! Σ I	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 I	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 I C	1..1	dateTime	Vital Signs vs-1: if Observation.effective[x] is dateTime are point in time measurements and has a value then that value shall be precise to are recorded using the day effectiveDateTime dateTime effectivePeriod Period data type
issued	Σ I	0..1	instant	Date/Time this version was made available
performer	Σ I	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson | HealthcareService | Group )	Who is responsible for the observation
value[x]	Σ I C	0..1	Quantity	The quantity for the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. vital sign being observed. valueQuantity Binding: Vital Signs Units ( Quantity preferred ) : Commonly encountered UCUM units for recording Vital Signs.
valueCodeableConcept dataAbsentReason	C	0..1	CodeableConcept	Why the result value is missing valueString Binding: string Data Absent Reason valueBoolean ( boolean extensible valueInteger ) : integer Codes specifying why the result ( Observation.value[x] ) is missing.
valueRange Range interpretation valueRatio		0..*	Ratio CodeableConcept	High, low, normal, etc valueSampledData Binding: SampledData Observation Interpretation Codes valueTime ( extensible ) time : Codes identifying interpretations of observations.
valueDateTime interpretationContext		0..*	CodeableReference ( Resource )	Context for understanding the observation valuePeriod Binding: Observation Interpretation Context Codes ( example ) Period : Codes identifying contextual factors that affect interpretation of observations.
dataAbsentReason note		0..*	CodeableConcept Annotation	Comments about the result is missing observation Binding: DataAbsentReason ( extensible )
interpretation bodySite		0..1	CodeableConcept	DEPRECATED: Observed body part High, low, normal, etc. Binding: Observation Interpretation Codes ( extensible SNOMED CT Body Structures ) note ( example I ) 0..* Annotation : Comments about the observation SNOMED CT Body site concepts
bodySite bodyStructure		0..1	CodeableConcept CodeableReference ( BodyStructure )	Observed body part 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 I	0..1	Reference ( Specimen | Group )	Specimen used for this observation
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	C I	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 I	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C I	0..1	SimpleQuantity Quantity	Low Range, if relevant
high	C I	0..1	SimpleQuantity Quantity	High Range, if relevant
type normalValue		0..1	I CodeableConcept	Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( 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 I	0..1	string markdown	Text based reference range in an observation
hasMember	Σ I	0..*	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Used when reporting observations included in a vital signs panel components
derivedFrom	Σ I	0..*	Reference ( DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile Observation )	Related measurements resource from which the observation is made from
component	Σ I 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 I	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ I C	1..1	CodeableConcept	Vital Sign measurement or component observation (code / type) Binding: Vital Signs LOINC codes with Observation or Both ( extensible example ) : Codes identifying names of simple observations.
Slices for value[x]	Σ C	S Σ 0 I .. 1	0..1	The value for the vital sign component being observed. Vital Sign Value recorded with UCUM Slice: Binding: Unordered, Open by type:$this Vital Signs Units ( required )
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 (Any)
dataAbsentReason value[x]:valueQuantity	Σ S C	0..1	Quantity	Vital Sign component value recorded as a component with UCUM (preferred) Binding: I 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: DataAbsentReason Data Absent Reason ( extensible ) : Codes specifying why the result ( Observation.value[x] ) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. 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

<!-- observation-vitalsigns -->

<!-- Observationvitalsignsbase -->


< xmlns="http://hl7.org/fhir"

<Observation xmlns="http://hl7.org/fhir"

>
  <!-- from Element: extension -->
 <</id>
 <</meta>
 <
 <
 <

 <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>
 <<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 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
 <

 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 

     Business Identifier for observation --></identifier>
 <</basedOn>
 <</partOf>
 <
 
 <
  <
   <
   <
   <
   <
   <
  </coding>
  <
 </category>
 <</code>
 <

 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <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><!-- 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>
 <

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

     What the observation is about, when it is not about the subject of record --></focus>
 <
     Healthcare event during which this observation is made</encounter>
 <
     Often just a dateTime for Vital Signs</effective[x]>
 <
 <

 <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. 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>
 <|
   
     Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.</value[x]>
 <</dataAbsentReason>
 <</interpretation>
 <</note>
 <</bodySite>
 <</method>
 <</specimen>
 <</device>
 <
  <<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 manageable, 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) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
  <

 <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><!-- 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 -->
  <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>
  <</type>
  <</appliesTo>
  <

  <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>
 <
     Used when reporting vital signs panel components</hasMember>
 <
     Related measurements the observation is made from</derivedFrom>
 <
  <<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 manageable, 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) (this element modifies the meaning of other elements)" class="dict"></modifierExtension>
  <</code>
  <|
    </value[x]>
  <</dataAbsentReason>
  <</interpretation>
  <</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 -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <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
    "
    "
    "
    "
    "
    "<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 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">
    "
    "
    "
    "
    " 
      { //  

    "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
    "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
    "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

  }