This structure is derived from Observation .

Summary

" "#### 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"
   • a fixed Observation.category.coding.code = "vital-signs"

3. A code in Observation.code

   • a fixed Observation.code.coding.system = "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 there is no value, one code in Observation.DataAbsentReason

   • if a numeric values use Observation.valueQuantity vital sign measure then:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code which has an extensible 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""
     • 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

   • if a numeric value use Observation.valueQuantity which has an extensible binding to the Vital Signs Units value set. 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""

Mandatory: 9 elements (+1 nested mandatory element)
Must-Support: 15 16 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices :

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

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

Name	Flags	Card.	Type	Description & Constraints
Observation	I C	0..*	Observation	FHIR Vital Signs Profile vs-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	code	registered | preliminary | final | amended + Binding: ObservationStatus Observation Status ( required )
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation
coding	S	1..*	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code	S	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
code	S	1..1	CodeableConcept	Coded Responses from C-CDA Vital Sign Results Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
subject	S	1..1	Reference ( Patient )	Who and/or what the observation is about
effective[x]	S I C	1..1		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
effectiveDateTime			dateTime
effectivePeriod			Period
value[x]	S I C	0..1	Quantity , CodeableConcept , string , boolean , integer , Range , Ratio , SampledData , time , dateTime , Period , Attachment , Reference ( MolecularSequence )	Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. Binding: Vital Signs Units ( extensible ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM.
dataAbsentReason	S I C	0..1	CodeableConcept	Why the result is missing
hasMember		0 .. *	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Used when reporting vital signs panel components
derivedFrom		0 .. *	Reference ( DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Related measurements resource from which the observation is made from
component	S I C	0 .. *	BackboneElement	Used when reporting systolic and diastolic blood pressure. vs-3: If there is no a value a data absent reason must be present
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
value[x]	S I C	0..1	Quantity , CodeableConcept , string , boolean , integer , Range , Ratio , SampledData , time , dateTime , Period , Attachment , Reference ( MolecularSequence )	Vital Sign Value
valueQuantity	S	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units ( extensible required ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM. Signs.
dataAbsentReason	S I C	0..1	CodeableConcept	Why the component result 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	I C	0..*	Observation	FHIR Vital Signs Profile vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?! Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common All Languages ( preferred required ): IETF language tag for a human language Additional Bindings Purpose All Languages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn instantiates[x]	Σ TU	0..* 0..1	canonical ( ObservationDefinition ), Reference ( ObservationDefinition )	Instantiates FHIR ObservationDefinition
basedOn	Σ	0..*	Reference ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest )	Fulfills plan, proposal or order
triggeredBy	TU	0..*	BackboneElement	Triggering observation(s)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ	1..1	code	reflex | repeat | re-run Binding: triggered Bytype ( required ): The type of TriggeredBy Observation.
reason		0..1	string	Reason that the observation was triggered
partOf	Σ	0..*	Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy )	Part of referenced event
status	?! S Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus Observation Status ( required )
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: Observation Category Codes ( preferred ) : Codes for high level observation categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes ( preferred ): Codes for high level observation categories.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	S Σ	1..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	S Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version	Σ	0..1	string	Version of the system - if relevant
code	S Σ C	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ C	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	S Σ C	1..1	CodeableConcept	Coded Responses from C-CDA Vital Sign Results Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
subject	S Σ	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	Σ TU	0..*	Reference ( Resource )	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference ( Encounter )	Healthcare event during which this observation is made
effective[x]	S Σ I C	1..1		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
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson )	Who is responsible for the observation
value[x]	S Σ I C	0..1		Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. Binding: Vital Signs Units ( extensible ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM.
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence )
dataAbsentReason	S I C	0..1	CodeableConcept	Why the result 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.
note		0..*	Annotation	Comments about the observation
bodySite	C	0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures ( example ): SNOMED CT Body site concepts
method bodyStructure	C TU	0..1	Reference ( BodyStructure )	Observed body structure
method		0..1	CodeableConcept	How it was done Binding: Observation Methods ( example ): Methods for simple observations.
specimen	C	0..1	Reference ( Specimen | Group )	Specimen used for this observation
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	I C	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	I C	0..1	SimpleQuantity	Low High Range, if relevant
high normalValue	I TU	0..1	SimpleQuantity CodeableConcept	High Range, Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( extensible ): Codes identifying the normal value of the observation.
type	TU	0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes ( preferred ): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes ( example ): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text	C	0..1	string markdown	Text based reference range in an observation
hasMember	Σ	0..*	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Used when reporting vital signs panel components
derivedFrom	Σ	0..*	Reference ( DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Related measurements resource from which the observation is made from
component	S Σ I C	0..*	BackboneElement	Used when reporting systolic and diastolic blood pressure. vs-3: If there is no a value a data absent reason must be present
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S Σ C	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
Slices for value[x]	S Σ I C 0..1	0 .. 1		Vital Sign Value recorded with UCUM Binding: Vital Signs Units ( extensible ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM. Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence )
dataAbsentReason value[x]:valueQuantity	S I Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units ( required ): Commonly encountered UCUM units for recording Vital Signs.
dataAbsentReason	S C	0..1	CodeableConcept	Why the component result 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
Documentation for this format

<!-- observation-vitalsigns -->

<!-- Observationvitalsigns -->


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

 <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.

 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <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>
 <

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><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 

     Business Identifier for observation --></identifier>
 <</basedOn>
 <</partOf>
 <

 <instantiates[x]><!-- I 0..1 canonical|Reference(ObservationDefinition) 
     Instantiates FHIR ObservationDefinition --></instantiates[x]>
 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <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 | preliminary | final | amended +   -->

 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <
  <
   <
   <
   <
   <
   <

 <category> I 1..1 CodeableConcept  <!-- I 1..1 Classification of  type of observation -->
  <coding> I 1..* Coding  <!-- I 1..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- I 1..1 Identity of the terminology system -->
   <version value="[string]"/><!-- I 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- I 1..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!-- I 0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!-- I 0..1 If this coding was chosen directly by the user -->

  </coding>
  <

  <text value="[string]"/><!-- I 0..1 Plain text representation of the concept -->

 </category>
 <</code>
 <

 <code><!-- I 1..1 CodeableConcept Coded Responses from C-CDA Vital Sign Results   --></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>
 <

 <encounter><!-- I 0..1 Reference(Encounter) 

     Healthcare event during which this observation is made --></encounter>
 <

 <effective[x]><!-- I 1..1 dateTime|Period 

     Often just a dateTime for Vital Signs --></effective[x]>
 <
 <

 <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>
 <|
   </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.

 <value[x]><!-- I 0..1 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period|Attachment|Reference(MolecularSequence) 

     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><!-- I 0..1 CodeableConcept Why the result is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <bodySite><!-- I 0..1 CodeableConcept Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 Reference(BodyStructure) 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 -->
  <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>
  <

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><!-- 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>
 <

 <hasMember><!-- I 0..* Reference(QuestionnaireResponse) 

     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.

 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Used when reporting systolic and diastolic blood pressure. -->
  <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>

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><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!-- I 1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <-- value[x] sliced by type:$this  in the specified orderOpen-->

  <valueQuantity><!-- I 0..1 Quantity Vital Sign Value recorded with UCUM   --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result 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 --></referenceRange>
 </component>
</Observation>

{ // 

{ // Observationvitalsigns

  // 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.

    "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
    "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">
    "
    "
    "
    "

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" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation
  // value[x]: Instantiates FHIR ObservationDefinition. One of these 2:

    "instantiatesCanonical" : "<canonical>", // IInstantiates FHIR ObservationDefinition
    "instantiatesReference" : { Reference(ObservationDefinition) }, // IInstantiates FHIR ObservationDefinition
    "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 | preliminary | final | amended +

    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { //  

      { // Classification of  type of observation // I R! 

        // from Element: extension
        " ]
        "
        "

        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // I R! Code defined by a terminology system
        "text" : "<string>" // IPlain text representation of the concept

      }
    ],
    "
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    "

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    "code" : { CodeableConcept }, // I R! Coded Responses from C-CDA Vital Sign Results
    "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
    "encounter" : { Reference(Encounter) }, // IHealthcare event during which this observation is made
  // value[x]: Often just a dateTime for Vital Signs. One of these 2:

    "effectiveDateTime" : "<dateTime>", // I R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // I R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
  // value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 13:

    "valueQuantity" : { Quantity }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueCodeableConcept" : { CodeableConcept }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueString" : "<string>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueBoolean" : <boolean>, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueInteger" : <integer>, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRange" : { Range }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRatio" : { Ratio }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueSampledData" : { SampledData }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueTime" : "<time>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueDateTime" : "<dateTime>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valuePeriod" : { Period }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueAttachment" : { Attachment }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueReference" : { Reference(MolecularSequence) }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "dataAbsentReason" : { CodeableConcept }, // IWhy the result is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "note" : [{ Annotation }], // IComments about the observation
    "bodySite" : { CodeableConcept }, // IObserved body part
    "bodyStructure" : { Reference(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(QuestionnaireResponse) }], // IUsed when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IUsed when reporting systolic and diastolic blood pressure.

  }

Summary

" "#### 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"
   • a fixed Observation.category.coding.code = "vital-signs"

3. A code in Observation.code

   • a fixed Observation.code.coding.system = "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 there is no value, one code in Observation.DataAbsentReason

   • if a numeric values use Observation.valueQuantity vital sign measure then:
     • One numeric value in Observation.valueQuantity.value
     • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
     • a UCUM unit code in Observation.valueQuantity.code which has an extensible 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""
     • 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

   • if a numeric value use Observation.valueQuantity which has an extensible binding to the Vital Signs Units value set. 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""

Mandatory: 9 elements (+1 nested mandatory element)
Must-Support: 15 16 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices :

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

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	I C	0..*	Observation	FHIR Vital Signs Profile vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?! Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common All Languages ( preferred required ): IETF language tag for a human language Additional Bindings Purpose All Languages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn instantiates[x]	Σ TU	0..* 0..1	canonical ( ObservationDefinition ), Reference ( ObservationDefinition )	Instantiates FHIR ObservationDefinition
basedOn	Σ	0..*	Reference ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest )	Fulfills plan, proposal or order
triggeredBy	TU	0..*	BackboneElement	Triggering observation(s)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
observation	Σ	1..1	Reference ( Observation )	Triggering observation
type	Σ	1..1	code	reflex | repeat | re-run Binding: triggered Bytype ( required ): The type of TriggeredBy Observation.
reason		0..1	string	Reason that the observation was triggered
partOf	Σ	0..*	Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy )	Part of referenced event
status	?! S Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus Observation Status ( required )
Slices for category	S	1 .. *	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: Observation Category Codes ( preferred ) : Codes for high level observation categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes ( preferred ): Codes for high level observation categories.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	S Σ	1..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	S Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version	Σ	0..1	string	Version of the system - if relevant
code	S Σ C	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ C	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	S Σ C	1..1	CodeableConcept	Coded Responses from C-CDA Vital Sign Results Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
subject	S Σ	1..1	Reference ( Patient )	Who and/or what the observation is about
focus	Σ TU	0..*	Reference ( Resource )	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference ( Encounter )	Healthcare event during which this observation is made
effective[x]	S Σ I C	1..1		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
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson )	Who is responsible for the observation
value[x]	S Σ I C	0..1		Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. Binding: Vital Signs Units ( extensible ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM.
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence )
dataAbsentReason	S I C	0..1	CodeableConcept	Why the result 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.
note		0..*	Annotation	Comments about the observation
bodySite	C	0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures ( example ): SNOMED CT Body site concepts
method bodyStructure	C TU	0..1	Reference ( BodyStructure )	Observed body structure
method		0..1	CodeableConcept	How it was done Binding: Observation Methods ( example ): Methods for simple observations.
specimen	C	0..1	Reference ( Specimen | Group )	Specimen used for this observation
device		0..1	Reference ( Device | DeviceMetric )	A reference to the device that generates the measurements or the device settings for the device
referenceRange	I C	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	I C	0..1	SimpleQuantity	Low High Range, if relevant
high normalValue	I TU	0..1	SimpleQuantity CodeableConcept	High Range, Normal value, if relevant Binding: Observation Reference Range Normal Value Codes ( extensible ): Codes identifying the normal value of the observation.
type	TU	0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes ( preferred ): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes ( example ): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text	C	0..1	string markdown	Text based reference range in an observation
hasMember	Σ	0..*	Reference ( QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Used when reporting vital signs panel components
derivedFrom	Σ	0..*	Reference ( DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Profile )	Related measurements resource from which the observation is made from
component	S Σ I C	0..*	BackboneElement	Used when reporting systolic and diastolic blood pressure. vs-3: If there is no a value a data absent reason must be present
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?! Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S Σ C	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs ( extensible ): This identifies the vital sign result type. Original source C-CDA R1.1 , HITSP Vital Sign Result Type.
Slices for value[x]	S Σ I C 0..1	0 .. 1		Vital Sign Value recorded with UCUM Binding: Vital Signs Units ( extensible ): Commonly encountered UCUM units for recording Vital Signs quantity units as codes. If extending this valueset the codes SHOULD come from UCUM. Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
valueAttachment			Attachment
valueReference			Reference ( MolecularSequence )
dataAbsentReason value[x]:valueQuantity	S I Σ	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units ( required ): Commonly encountered UCUM units for recording Vital Signs.
dataAbsentReason	S C	0..1	CodeableConcept	Why the component result 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
Documentation for this format

<!-- observation-vitalsigns -->

<!-- Observationvitalsigns -->


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

 <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.

 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <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>
 <

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><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 

     Business Identifier for observation --></identifier>
 <</basedOn>
 <</partOf>
 <

 <instantiates[x]><!-- I 0..1 canonical|Reference(ObservationDefinition) 
     Instantiates FHIR ObservationDefinition --></instantiates[x]>
 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <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 | preliminary | final | amended +   -->

 <-- category sliced by value:coding.code, value:coding.system  in the specified orderOpen-->
 <
  <
   <
   <
   <
   <
   <

 <category> I 1..1 CodeableConcept  <!-- I 1..1 Classification of  type of observation -->
  <coding> I 1..* Coding  <!-- I 1..* Code defined by a terminology system -->
   <system value="[uri]"/><!-- I 1..1 Identity of the terminology system -->
   <version value="[string]"/><!-- I 0..1 Version of the system - if relevant -->
   <code value="[code]"/><!-- I 1..1 Symbol in syntax defined by the system -->
   <display value="[string]"/><!-- I 0..1 Representation defined by the system -->
   <userSelected value="[boolean]"/><!-- I 0..1 If this coding was chosen directly by the user -->

  </coding>
  <

  <text value="[string]"/><!-- I 0..1 Plain text representation of the concept -->

 </category>
 <</code>
 <

 <code><!-- I 1..1 CodeableConcept Coded Responses from C-CDA Vital Sign Results   --></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>
 <

 <encounter><!-- I 0..1 Reference(Encounter) 

     Healthcare event during which this observation is made --></encounter>
 <

 <effective[x]><!-- I 1..1 dateTime|Period 

     Often just a dateTime for Vital Signs --></effective[x]>
 <
 <

 <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>
 <|
   </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.

 <value[x]><!-- I 0..1 Quantity|CodeableConcept|string|boolean|integer|
   Range|Ratio|SampledData|time|dateTime|Period|Attachment|Reference(MolecularSequence) 

     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><!-- I 0..1 CodeableConcept Why the result is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <bodySite><!-- I 0..1 CodeableConcept Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 Reference(BodyStructure) 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 -->
  <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>
  <

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><!-- 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>
 <

 <hasMember><!-- I 0..* Reference(QuestionnaireResponse) 

     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.

 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Used when reporting systolic and diastolic blood pressure. -->
  <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>

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><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!-- I 1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <-- value[x] sliced by type:$this  in the specified orderOpen-->

  <valueQuantity><!-- I 0..1 Quantity Vital Sign Value recorded with UCUM   --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result 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 --></referenceRange>
 </component>
</Observation>

{ // 

{ // Observationvitalsigns

  // 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.

    "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
    "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">
    "
    "
    "
    "

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" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation
  // value[x]: Instantiates FHIR ObservationDefinition. One of these 2:

    "instantiatesCanonical" : "<canonical>", // IInstantiates FHIR ObservationDefinition
    "instantiatesReference" : { Reference(ObservationDefinition) }, // IInstantiates FHIR ObservationDefinition
    "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 | preliminary | final | amended +

    "category" : [ //  sliced by value:coding.code, value:coding.system  in the specified order, Open 
      { //  

      { // Classification of  type of observation // I R! 

        // from Element: extension
        " ]
        "
        "

        "extension" : [ //  sliced by value:url  in the specified order, Open ]
        "coding" : [{ Coding }], // I R! Code defined by a terminology system
        "text" : "<string>" // IPlain text representation of the concept

      }
    ],
    "
    "
    "
    "

    "
    "
    "
    "

    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "

    "code" : { CodeableConcept }, // I R! Coded Responses from C-CDA Vital Sign Results
    "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
    "encounter" : { Reference(Encounter) }, // IHealthcare event during which this observation is made
  // value[x]: Often just a dateTime for Vital Signs. One of these 2:

    "effectiveDateTime" : "<dateTime>", // I R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // I R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
  // value[x]: Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.. One of these 13:

    "valueQuantity" : { Quantity }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueCodeableConcept" : { CodeableConcept }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueString" : "<string>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueBoolean" : <boolean>, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueInteger" : <integer>, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRange" : { Range }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueRatio" : { Ratio }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueSampledData" : { SampledData }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueTime" : "<time>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueDateTime" : "<dateTime>", // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valuePeriod" : { Period }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueAttachment" : { Attachment }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "valueReference" : { Reference(MolecularSequence) }, // IVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
    "dataAbsentReason" : { CodeableConcept }, // IWhy the result is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "note" : [{ Annotation }], // IComments about the observation
    "bodySite" : { CodeableConcept }, // IObserved body part
    "bodyStructure" : { Reference(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(QuestionnaireResponse) }], // IUsed when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IUsed when reporting systolic and diastolic blood pressure.

  }