This
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part
of
the
FHIR
Specification
(v4.0.1:
R4
(v5.0.0-ballot:
R5
Ballot
-
Mixed
Normative
and
STU
see
ballot
notes
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in
it's
permanent
home
(it
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available
at
this
URL).
).
The
current
version
which
supercedes
this
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is
5.0.0
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For
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full
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of
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versions,
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of
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versions
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Page
versions:
R5
R4B
BodyWeight
This
Code
system
is
used
in
the
following
value
sets:
<?xml version="1.0" encoding="UTF-8"?>
#### Complete Summary of the Mandatory Requirements
1. One code in `Observation.code` which must have
- a fixed `Observation.code.coding.system`=**'http ://loinc.org'**
- a fixed `Observation.code.coding.code`= **'29463-7'**
- Other additional Codings are allowed in `Observation.code`- e.g. more specific
LOINC
Codes, SNOMED CT concepts, system specific codes. All codes
SHALL have an system value
1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsent
Reason
- Each Observation.valueQuantity must have:
- One numeric value in Observation.valueQuantity.value
- a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
- a UCUM unit code in Observation.valueQuantity.code = **'kg', 'g', or '[lb_av]'**
This profile defines how to represent body weight observations in FHIR using a standard
LOINC code and UCUM units of measure.
Used for simple observations such as device measurements, laboratory atomic results, vital
signs, height, weight, smoking status, comments, etc. Other resources are used to provide
context for observations such as laboratory reports, etc.
If the resource is contained in another resource, it SHALL be referred to from elsewhere
in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonica
l) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(refer
ence = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(c
anonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:refere
nce/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or
a meta.lastUpdated
When a resource has no narrative, only systems that fully understand the data can display
the resource to a human safely. Including a human readable representation in the resource
makes for a much more robust eco-system and cheaper handling of resources by intermediary
systems. Some ecosystems restrict distribution of resources to only those systems that
do fully understand the resources, and as a consequence implementers may believe that
the narrative is superfluous. However experience shows that such eco-systems often open
up to new participants over time.
If Observation.code is the same as an Observation.component.code then the value element
associated with the code SHALL NOT be present
not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return
f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@
value]))
If there is no component or hasMember element then either a value[x] or a data absent
reason must be present.
The logical id of the resource, as used in the URL for the resource. Once assigned, this
value never changes.
The only time that a resource does not have an id is when it is being submitted to the
server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure.
Changes to the content might not always be associated with version changes to the resource.
A reference to a set of rules that were followed when the resource was constructed, and
which must be understood when processing the content. Often, this is a reference to an
implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of
trading partners. This inherently limits the usefulness of the data in the long term.
However, the existing health eco-system is highly fractured, and not yet ready to define,
collect, and exchange data in a generally computable sense. Wherever possible, implementers
and/or specification writers should avoid using this element. Often, when used, the URL
is a reference to an implementation guide that defines these special rules as part of
it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional
knowledge about the resource that modifies it's meaning or interpretation
Language is provided to support indexing and accessibility (typically, services such as
text to speech use the language tag). The html language tag in the narrative applies
to the narrative. The language tag on the resource may be used to specify the language
of other presentations generated from the data in the resource. Not all the content has
to be in the base language. The Resource.language should not be assumed to apply to the
narrative automatically. If a language is specified, it should it also be specified on
the div element in the html (see rules in HTML5 for information about the relationship
between xml:lang and the html lang attribute).
A human-readable narrative that contains a summary of the resource and can be used to
represent the content of the resource to a human. The narrative need not encode all the
structured data, but is required to contain sufficient detail to make it "clinically
safe" for a human to just read the narrative. Resource definitions may define what
content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have
a narrative. In some cases, a resource may only have text with little or no additional
discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary
for data from legacy systems where information is captured as a "text blob"
or where text is additionally entered raw or narrated and encoded information is added
later.
These resources do not have an independent existence apart from the resource that contains
them - they cannot be identified independently, and nor can they have their own independent
transaction scope.
This should never be done when the content can be identified properly, as once identification
is lost, it is extremely difficult (and context dependent) to restore it again. Contained
resources may have profiles and tags In their meta elements, but SHALL NOT have security
labels.
May be used to represent additional information that is not part of the basic definition
of the resource. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
May be used to represent additional information that is not part of the basic definition
of the 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).
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly
distinguished from the vast majority of extensions which can be safely ignored. This
promotes interoperability by eliminating the need for implementers to prohibit the presence
of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/f
hir/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource
that contains them
OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR
and OBX must be negotiated between trading partners to uniquely identify the OBX segment.
Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3
+ OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC
+ OBX-3 + OBX-4.
A plan, proposal or order that is fulfilled in whole or in part by this event. For example,
a MedicationRequest may require a patient to have laboratory test performed before it
is dispensed.
Allows tracing of authorization for the event and tracking whether proposals/recommendations
were acted upon.
A larger event of which this particular Observation is a component or step. For example,
an observation as part of a procedure.
To link an Observation to an Encounter use `encounter`. See the [Notes](http://hl7.org/fhir/observ
ation.html#obsgrouping) below for guidance on referencing another Observation.
This element is labeled as a modifier because the status contains codes that mark the
resource as not currently valid.
Need to track the status of individual results. Some results are finalized before the
whole report is finalized.
This element is labeled as a modifier because it is a status element that contains status
entered-in-error which means that the resource should not be treated as valid
status Amended & Final are differentiated by whether it is the subject of a ControlAct
event with a type of "revise"
In addition to the required category valueset, this element allows various categorization
schemes based on the owner’s definition of the category and effectively multiple categories
can be used at once. The level of granularity is defined by the category concepts in
the value set.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN&quo
t;].code
In addition to the required category valueset, this element allows various categorization
schemes based on the owner’s definition of the category and effectively multiple categories
can be used at once. The level of granularity is defined by the category concepts in
the value set.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN&quo
t;].code
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of
codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code
systems.
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be
references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of
FHIR defined special URIs or it should reference to some definition that establishes the
system clearly and unambiguously.
The version of the code system which was used when choosing this code. Note that a well-maintained
code system does not need the version reported, because the meaning of codes is consistent
across versions. However this cannot consistently be assured, and when the meaning is
not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code
system versions, the recommendation is to use the date (expressed in FHIR date format)
on which that version was officially published as the version date.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression
in a syntax defined by the coding system (e.g. post-coordination).
A representation of the meaning of the code in the system, following the rules of the
system.
Need to be able to carry a human-readable meaning of the code for readers that do not
know the system.
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available
items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting
point for new translations. There is some ambiguity about what exactly 'directly chosen'
implies, and trading partner agreement may be needed to clarify the use of this element
and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code
pair was chosen explicitly, rather than inferred by the system based on some rules or
language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected
fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target
dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true";
fhir:target dt:CDCoding.codingRationale\#O ]
A human language representation of the concept as seen/selected/uttered by the user who
entered the data and/or which represents the intended meaning of the user.
The codes from the terminologies do not always capture the correct meaning with all the
nuances of the human using them, or sometimes there is no appropriate code at all. In
these cases, the text is used to capture the full meaning of the source.
additional codes that translate or map to this code are allowed. For example a more granular
LOINC code or code that is used locally in a system.
5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet
HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of
codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code
systems.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions
such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of
codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one
of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code
systems.
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be
references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of
FHIR defined special URIs or it should reference to some definition that establishes the
system clearly and unambiguously.
The version of the code system which was used when choosing this code. Note that a well-maintained
code system does not need the version reported, because the meaning of codes is consistent
across versions. However this cannot consistently be assured, and when the meaning is
not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code
system versions, the recommendation is to use the date (expressed in FHIR date format)
on which that version was officially published as the version date.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression
in a syntax defined by the coding system (e.g. post-coordination).
A representation of the meaning of the code in the system, following the rules of the
system.
Need to be able to carry a human-readable meaning of the code for readers that do not
know the system.
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available
items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting
point for new translations. There is some ambiguity about what exactly 'directly chosen'
implies, and trading partner agreement may be needed to clarify the use of this element
and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code
pair was chosen explicitly, rather than inferred by the system based on some rules or
language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected
fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target
dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true";
fhir:target dt:CDCoding.codingRationale\#O ]
A human language representation of the concept as seen/selected/uttered by the user who
entered the data and/or which represents the intended meaning of the user.
The codes from the terminologies do not always capture the correct meaning with all the
nuances of the human using them, or sometimes there is no appropriate code at all. In
these cases, the text is used to capture the full meaning of the source.
The patient, or group of patients, location, or device this observation is about and into
whose record the observation is placed. If the actual focus of the observation is different
from the subject (or a sample of, part, or region of the subject), the `focus` element
or the `code` itself specifies the actual focus of the observation.
One would expect this element to be a cardinality of 1..1. The only circumstance in which
the subject can be missing is when the observation is made by a device that does not know
the patient. In this case, the observation SHALL be matched to a patient through some
context/channel matching technique, and at this point, the observation should be updated.
The actual focus of an observation when it is not the patient 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.
Typically, an observation is made about the subject - a patient, or group of patients,
location, or device - and the distinction between the subject and what is directly measured
for an observation is specified in the observation code itself ( e.g., "Blood Glucose")
and does not need to be represented separately using this element. Use `specimen` if
a reference to a specimen is required. If a code is required instead of a resource use
either `bodysite` for bodysites or the standard extension [focusCode](http://hl7.org/fhir/extension
-observation-focuscode.html).
The healthcare event (e.g. a patient and healthcare provider interaction) during which
this observation is made.
This will typically be the encounter the event occurred within, but some events may be
initiated prior to or after the official completion of an encounter but still be tied
to the context of the encounter (e.g. pre-admission laboratory tests).
For some observations it may be important to know the link between an observation and
a particular encounter.
At least a date should be present unless this observation is a historical report. For
recording imprecise or "fuzzy" times (For example, a blood glucose measurement
taken "after breakfast") use the [Timing](http://hl7.org/fhir/datatypes.html#timing)
datatype which allow the measurement to be tied to regular life events.
Knowing when an observation was deemed true is important to its relevance as well as determining
trends.
if Observation.effective[x] is dateTime and has a value then that value shall be precise
to the day
The date and time this version of the observation was made available to providers, typically
after the results have been reviewed and verified.
For Observations that don’t require review and verification, it may be the same as the
[`lastUpdated` ](http://hl7.org/fhir/resource-definitions.html#Meta.lastUpdated) time
of the resource itself. For Observations that do require review and verification for
certain updates, it might not be the same as the `lastUpdated` time of the resource itself
due to a non-clinically significant update that doesn’t require the new version to be
reviewed and verified again.
May give a degree of confidence in the observation and also indicates where follow-up
questions should be directed.
OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP'
/ (Organization) OBX-23, PRT-8:PRT-4='PO'
Vital Signs value are recorded using the Quantity data type. For supporting observations
such as Cuff size could use other datatypes such as CodeableConcept.
Vital Signs value are recorded using the Quantity data type. For supporting observations
such as Cuff size could use other datatypes such as CodeableConcept.
An observation may have; 1) a single value here, 2) both a value and a set of related
or component values, or 3) only a set of related or component values. If a value is
present, the datatype for this element should be determined by Observation.code. A CodeableConcept
with just a text would be used instead of a string if the field was usually coded, or
if the type associated with the Observation.code defines a coded value. For additional
guidance, see the [Notes section](http://hl7.org/fhir/observation.html#notes) below.
Vital Signs value are recorded using the Quantity data type. For supporting observations
such as Cuff size could use other datatypes such as CodeableConcept.
Vital Signs value are recorded using the Quantity data type. For supporting observations
such as Cuff size could use other datatypes such as CodeableConcept.
An observation may have; 1) a single value here, 2) both a value and a set of related
or component values, or 3) only a set of related or component values. If a value is
present, the datatype for this element should be determined by Observation.code. A CodeableConcept
with just a text would be used instead of a string if the field was usually coded, or
if the type associated with the Observation.code defines a coded value. For additional
guidance, see the [Notes section](http://hl7.org/fhir/observation.html#notes) below.
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
The value of the measured amount. The value includes an implicit precision in the presentation
of the value.
The implicit precision in the value should always be honored. Monetary values have their
own rules for handling precision (refer to standard accounting text books).
How the value should be understood and represented - whether the actual value is greater
or less than the stated value due to measurement issues; e.g. if the comparator is "<"
, then the real value is < stated value.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due
to the limitations of measuring methodology.
This is labeled as "Is Modifier" because the comparator modifies the interpretation
of the value significantly. If there is no comparator, then there is no modification of
the value
There are many representations for units of measure and in many contexts, particular representations
are fixed and required. I.e. mcg for micrograms.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or
ISO 4217 for currency. The context of use may additionally require a code from a particular
system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this
for quantities, but SNOMED CT provides many units of interest.
Null or exceptional values can be represented two ways in FHIR Observations. One way
is to simply include them in the value set and represent the exceptions in the value.
For example, measurement values for a serology test could be "detected", "not
detected", "inconclusive", or "specimen unsatisfactory".
The alternate way is to use the value element for actual observations and use the explicit
dataAbsentReason element to record exceptional values. For example, the dataAbsentReason
code "error" could be used when the measurement was not completed. Note that
an observation may only be reported if there are values to report. For example differential
cell counts values may be reported only when > 0. Because of these options, use-case
agreements are required to interpret general observations for null or exceptional values.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends
to other use cases where coded interpretations are relevant. Often reported as one or
more simple compact codes this element is often placed adjacent to the result value in
reports and flow sheets to signal the meaning/normalcy status of the result.
For some results, particularly numeric results, an interpretation is necessary to fully
understand the significance of a result.
May include general statements about the observation, or statements about significant,
unexpected or unreliable results values, or information about its source when relevant
to its interpretation.
Indicates the site on the subject's body where the observation was made (i.e. the target
site).
Only used if not implicit in code found in Observation.code. In many systems, this may
be represented as a related observation instead of an inline component.
If the use case requires BodySite to be handled as a separate resource (e.g. to identify
and track separately) then use the standard extension[ bodySite](http://hl7.org/fhir/extension-bodys
ite.html).
In some cases, method can impact results and is thus used for determining whether results
can be compared or determining significance of results.
Should only be used if not implicit in code found in `Observation.code`. Observations
are not made on specimens themselves; they are made on a subject, but in many cases by
the means of a specimen. Note that although specimens are often involved, they are not
always tracked and reported explicitly. Also note that observation resources may be used
in contexts that track the specimen explicitly (e.g. Diagnostic Report).
Note that this is not meant to represent a device involved in the transmission of the
result, e.g., a gateway. Such devices may be documented using the Provenance resource
where relevant.
Guidance on how to interpret the value by comparison to a normal or recommended range.
Multiple reference ranges are interpreted as an "OR". In other words, to
represent two distinct target populations, two `referenceRange` elements would be used.
Most observations only have one generic reference range. Systems MAY choose to restrict
to only supplying the relevant reference range based on knowledge about the patient (e.g.,
specific to the patient's age, gender, weight and other factors), but this might not be
possible or appropriate. Whenever more than one reference range is supplied, the differences
between them SHOULD be provided in the reference range and/or age properties.
Knowing what values are considered "normal" can help evaluate the significance
of a particular result. Need to be able to provide multiple reference ranges for different
contexts.
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
May be used to represent additional information that is not part of the basic definition
of the element and that modifies the understanding of the element 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).
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly
distinguished from the vast majority of extensions which can be safely ignored. This
promotes interoperability by eliminating the need for implementers to prohibit the presence
of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/f
hir/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element
that contains them
The value of the low bound of the reference range. The low bound of the reference range
endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the
low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
The value of the high bound of the reference range. The high bound of the reference range
endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the
high bound is omitted, it is assumed to be meaningless (e.g. reference range is >=
2.3).
Codes to indicate the what part of the targeted reference population it applies to. For
example, the normal or therapeutic range.
This SHOULD be populated if there is more than one range. If this element is not present
then the normal range is assumed.
Need to be able to say what kind of reference range this is - normal, recommended, therapeutic,
etc., - for proper interpretation.
< 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
Codes to indicate the target population this reference range applies to. For example,
a reference range may be based on the normal population or a particular sex or race.
Multiple `appliesTo` are interpreted as an "AND" of the target populations.
For example, to represent a target population of African American females, both a code
of female and a code for African American would be used.
This SHOULD be populated if there is more than one range. If this element is not present
then the normal population is assumed.
< 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
The age at which this reference range is applicable. This is a neonatal age (e.g. number
of weeks at term) if the meaning says so.
Text based reference range in an observation which may be used when a quantitative range
is not appropriate for an observation. An example would be a reference value of "Negative"
; or a list or table of "normals".
When using this element, an observation will typically have either a value or a set of
related resources, although both may be present in some cases. For a discussion on the
ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/observation.html
#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](http://hl
7.org/fhir/questionnaireresponse.html) into a final score and represent the score as an
Observation.
The target resource that represents a measurement from which this observation value is
derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound
image.
All the reference choices that are listed in this element can represent clinical observations
and other measurements that may be the source for a derived value. The most common reference
will be another Observation. For a discussion on the ways Observations can assembled
in groups together, see [Notes](http://hl7.org/fhir/observation.html#obsgrouping) below.
For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7
.org/fhir/observation.html#notes) below.
Component observations share the same attributes in the Observation resource as the primary
observation and are always treated a part of a single observation (they are not separable).
However, the reference range for the primary observation value is not inherited by the
component values and is required when appropriate for each component observation.
Unique id for the element within a resource (for internal references). This may be any
string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition
of the element. 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.
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
May be used to represent additional information that is not part of the basic definition
of the element and that modifies the understanding of the element 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).
There can be no stigma associated with the use of extensions by any application, project,
or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
The use of extensions is what allows the FHIR specification to retain a core level of
simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly
distinguished from the vast majority of extensions which can be safely ignored. This
promotes interoperability by eliminating the need for implementers to prohibit the presence
of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/f
hir/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element
that contains them
*All* code-value and component.code-component.value pairs need to be taken into account
to correctly understand the meaning of the observation.
< 363787002 |Observable entity| OR
< 386053000 |Evaluation procedure|
Used when observation has a set of component observations. An observation may have both
a value (e.g. an Apgar score) and component observations (the observations from which
the Apgar score was derived). If a value is present, the datatype for this element should
be determined by Observation.code. A CodeableConcept with just a text would be used instead
of a string if the field was usually coded, or if the type associated with the Observation.code
defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/observa
tion.html#notes) below.
Provides a reason why the expected value in the element Observation.component.value[x]
is missing.
"Null" or exceptional values can be represented two ways in FHIR Observations.
One way is to simply include them in the value set and represent the exceptions in the
value. For example, measurement values for a serology test could be "detected",
"not detected", "inconclusive", or "test not done".
The alternate way is to use the value element for actual observations and use the explicit
dataAbsentReason element to record exceptional values. For example, the dataAbsentReason
code "error" could be used when the measurement was not completed. Because
of these options, use-case agreements are required to interpret general observations for
exceptional values.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends
to other use cases where coded interpretations are relevant. Often reported as one or
more simple compact codes this element is often placed adjacent to the result value in
reports and flow sheets to signal the meaning/normalcy status of the result.
For some results, particularly numeric results, an interpretation is necessary to fully
understand the significance of a result.
Most observations only have one generic reference range. Systems MAY choose to restrict
to only supplying the relevant reference range based on knowledge about the patient (e.g.,
specific to the patient's age, gender, weight and other factors), but this might not be
possible or appropriate. Whenever more than one reference range is supplied, the differences
between them SHOULD be provided in the reference range and/or age properties.
Knowing what values are considered "normal" can help evaluate the significance
of a particular result. Need to be able to provide multiple reference ranges for different
contexts.
This profile defines how to represent body weight observations in FHIR using a standard
LOINC code and UCUM units of measure.
additional codes that translate or map to this code are allowed. For example a more granular
LOINC code or code that is used locally in a system.
This
code
system
http://hl7.org/fhir/imagingselection-status
defines
the
following
codes:
Code
</
StructureDefinition
Display
Definition
Copy
available
>
Available
The
selected
resources
are
available..
entered-in-error
Entered
in
Error
The
imaging
selection
has
been
withdrawn
following
a
release.
This
electronic
record
should
never
have
existed,
though
it
is
possible
that
real-world
decisions
were
based
on
it.
(If
real-world
activity
has
occurred,
the
status
should
be
"cancelled"
rather
than
"entered-in-error".).
unknown
Unknown
The
system
does
not
know
which
of
the
status
values
currently
applies
for
this
request.
Note:
This
concept
is
not
to
be
used
for
"other"
-
one
of
the
listed
statuses
is
presumed
to
apply,
it's
just
not
known
which
one.
Explanation
of
the
columns
that
may
appear
on
this
page:
Level
A
few
code
lists
that
FHIR
defines
are
hierarchical
-
each
code
is
assigned
a
level.
See
Code
System
for
further
information.
Source
The
source
of
the
definition
of
the
code
(when
the
value
set
draws
in
codes
defined
elsewhere)
Code
The
code
(used
as
the
code
in
the
resource
instance).
If
the
code
is
in
italics,
this
indicates
that
the
code
is
not
selectable
('Abstract')
Display
The
display
(used
in
the
display
element
of
a
Coding
).
If
there
is
no
display,
implementers
should
not
simply
display
the
code,
but
map
the
concept
into
their
application
Terminology
|
Propose
a
change
