Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build

Nictiz FHIR NL STU3 Zib2017 - Local Development build (v1.3.15) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: WoundCharacteristics - Detailed Descriptions

Draft as of 2024-04-09

Definitions for the WoundCharacteristics resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Observation
2. Observation.extension
SlicingThis element introduces a set of slices on Observation.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Observation.extension:woundImage
    Slice NamewoundImage
    TypeExtension(WoundImage extension for Observation resources) (Extension Type: Attachment)
    6. Observation.extension:woundImage.valueAttachment:valueAttachment
    Slice NamevalueAttachment
    Definition

    A photo of the wound.

    ShortWoundImage
    Alternate NamesWondFoto
    8. Observation.extension:reasonReference
    Slice NamereasonReference
    Control0..1
    TypeExtension(Reason Reference) (Extension Type: Reference(Condition, Observation))
    10. Observation.extension:reasonReference.value[x]
    TypeReference(Condition, Observation, HCIM PressureUlcer, HCIM Wound)
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    12. Observation.code
    14. Observation.code.coding
    Control1..?
    SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • 16. Observation.code.coding:WoundObservableCode
      Slice NameWoundObservableCode
      Control1..1
      18. Observation.code.coding:WoundObservableCode.system
      Control1..?
      Fixed Valuehttp://snomed.info/sct
      20. Observation.code.coding:WoundObservableCode.code
      Control1..?
      Fixed Value364554009
      22. Observation.component
      SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • pattern @ code
      • 24. Observation.component:WoundLength
        Slice NameWoundLength
        Control0..1
        26. Observation.component:WoundLength.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "401238003"
          }]
        }
        28. Observation.component:WoundLength.code.coding
        30. Observation.component:WoundLength.code.coding.display
        Default ValueLength of wound
        32. Observation.component:WoundLength.valueQuantity:valueQuantity
        Slice NamevalueQuantity
        Definition

        The length of the wound.

        ShortWoundLength
        TypeQuantity
        Alternate NamesWondlengte
        34. Observation.component:WoundWidth
        Slice NameWoundWidth
        Control0..1
        36. Observation.component:WoundWidth.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "401239006"
          }]
        }
        38. Observation.component:WoundWidth.code.coding
        Pattern Value{
          "system" : "http://snomed.info/sct",
          "code" : "401239006"
        }
        40. Observation.component:WoundWidth.code.coding.display
        Default ValueWidth of wound
        42. Observation.component:WoundWidth.valueQuantity:valueQuantity
        Slice NamevalueQuantity
        Definition

        The width of the decubitus wound.

        ShortWoundWidth
        TypeQuantity
        Alternate NamesWondbreedte
        44. Observation.component:WoundDepth
        Slice NameWoundDepth
        Control0..1
        46. Observation.component:WoundDepth.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "425094009"
          }]
        }
        48. Observation.component:WoundDepth.code.coding
        50. Observation.component:WoundDepth.code.coding.display
        Default ValueDepth of wound
        52. Observation.component:WoundDepth.valueQuantity:valueQuantity
        Slice NamevalueQuantity
        Definition

        The depth of the decubitus wound.

        ShortWoundDepth
        TypeQuantity
        Alternate NamesWonddiepte
        54. Observation.component:WoundTissue
        Slice NameWoundTissue
        Control0..1
        56. Observation.component:WoundTissue.code
        Pattern Value{
          "coding" : [{
            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
            "code" : "19.2.4"
          }]
        }
        58. Observation.component:WoundTissue.code.coding
        60. Observation.component:WoundTissue.code.coding.display
        Default ValueWound tissue
        62. Observation.component:WoundTissue.value[x]
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • type @ $this
        • 64. Observation.component:WoundTissue.value[x]:valueCodeableConcept
          Slice NamevalueCodeableConcept
          ShortWoundTissue
          Control1..?
          TypeCodeableConcept
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          Alternate NamesWondWeefsel
          66. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding
          Control0..1
          SlicingThis element introduces a set of slices on Observation.component.value[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ system
          • 68. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue
            Slice NameOncoUlcerCodelistValue
            Control0..1
            BindingThe codes SHALL be taken from WondWeefselOncoUlcerCodelijst
            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.2--20171231000000)

            WondWeefselOncoUlcerCodelijst

            70. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.system
            Control1..?
            Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.1
            72. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.code
            Control1..?
            74. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue
            Slice NameWCSCodelistValue
            Control0..1
            BindingThe codes SHALL be taken from WondWeefselWCSCodelijst
            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.1--20171231000000)

            WondWeefselWCSCodelijst

            76. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.system
            Control1..?
            Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.2
            78. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.code
            Control1..?
            80. Observation.component:WoundInfection
            Slice NameWoundInfection
            Control0..1
            82. Observation.component:WoundInfection.code
            Pattern Value{
              "coding" : [{
                "system" : "http://snomed.info/sct",
                "code" : "405009004"
              }]
            }
            84. Observation.component:WoundInfection.code.coding
            Control0..1
            86. Observation.component:WoundInfection.code.coding.display
            Default ValueInfection status
            88. Observation.component:WoundInfection.valueCodeableConcept:valueCodeableConcept
            Slice NamevalueCodeableConcept
            ShortWoundInfection
            BindingThe codes SHALL be taken from v2 Yes/no Indicator
            (required to http://hl7.org/fhir/ValueSet/v2-0136)

            v2 Yes/no Indicator

            TypeCodeableConcept
            Alternate NamesWondInfectie
            90. Observation.component:WoundMoisture
            Slice NameWoundMoisture
            Control0..1
            92. Observation.component:WoundMoisture.code
            Pattern Value{
              "coding" : [{
                "system" : "http://snomed.info/sct",
                "code" : "298007001"
              }]
            }
            94. Observation.component:WoundMoisture.valueCodeableConcept:valueCodeableConcept
            Slice NamevalueCodeableConcept
            Definition

            Description of the moisture in the wound.

            ShortWoundMoisture
            BindingUnless not suitable, these codes SHALL be taken from WondVochtigheidCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.3--20171231000000)

            WondVochtigheidCodelijst

            TypeCodeableConcept
            Alternate NamesWondVochtigheid
            96. Observation.component:WoundEdge
            Slice NameWoundEdge
            Control0..1
            98. Observation.component:WoundEdge.code
            Pattern Value{
              "coding" : [{
                "system" : "http://snomed.info/sct",
                "code" : "449747006"
              }]
            }
            100. Observation.component:WoundEdge.code.coding
            102. Observation.component:WoundEdge.code.coding.display
            Default ValueWound edge finding
            104. Observation.component:WoundEdge.valueCodeableConcept:valueCodeableConcept
            Slice NamevalueCodeableConcept
            Definition

            Description of the condition of the outer edges of the wound.

            ShortWoundEdge
            BindingUnless not suitable, these codes SHALL be taken from WondRandCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.5--20171231000000)

            WondRandCodelijst

            TypeCodeableConcept
            Alternate NamesWondRand

            Guidance on how to interpret the contents of this table can be found here

            0. Observation
            Definition

            Measurements and simple assertions made about a patient, device or other subject.

            ShortMeasurements and simple assertions
            Comments

            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 lab reports, etc.

            Control0..*
            Alternate NamesVital Signs, Measurement, Results, Tests
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
            obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
            obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
            dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
            obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
            obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
            2. Observation.implicitRules
            Definition

            A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

            ShortA set of rules under which this content was created
            Comments

            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.

            This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

            Control0..1
            Typeuri
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            4. Observation.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortExtensionAdditional Content defined by implementations
            Comments

            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.

            Control0..*
            TypeExtension
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Observation.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 6. Observation.extension:woundImage
              Slice NamewoundImage
              Definition

              Optional Extension Element - found in all resources.

              ShortOptional Extensions Element
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(WoundImage extension for Observation resources) (Extension Type: Attachment)
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              8. Observation.extension:woundImage.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control1..1
              Typeuri
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/observation-woundImage
              10. Observation.extension:woundImage.value[x]
              Definition

              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

              ShortValue of extension
              Control0..1
              TypeAttachment, date, dateTime, Meta, code, string, Address, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              SlicingThis element introduces a set of slices on Observation.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 12. Observation.extension:woundImage.value[x]:valueAttachment
                Slice NamevalueAttachment
                Definition

                A photo of the wound.


                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortWoundImageValue of extension
                Control0..1
                TypeAttachment, date, dateTime, Meta, code, string, Address, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Alternate NamesWondFoto
                14. Observation.extension:reasonReference
                Slice NamereasonReference
                Definition

                Indicates another resource whose existence justifies this event.

                ShortWhy was event performed?
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Reason Reference) (Extension Type: Reference(Condition, Observation))
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                16. Observation.extension:reasonReference.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/event-reasonReference
                18. Observation.extension:reasonReference.value[x]
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortValue of extension
                Control10..1
                TypeReference(Condition, Observation, HCIM PressureUlcer, HCIM Wound), date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                20. Observation.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                ShortExtensions that cannot be ignored
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Alternate Namesextensions, user content
                22. Observation.status
                Definition

                The status of the result value.

                Shortregistered | preliminary | final | amended +
                Comments

                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status
                (required to http://hl7.org/fhir/ValueSet/observation-status)

                Codes providing the status of an observation.

                Typecode
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                24. Observation.code
                Definition

                Describes what was observed. Sometimes this is called the observation "name".

                ShortType of observation (code / type)
                Control1..1
                BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                (example to http://hl7.org/fhir/ValueSet/observation-codes)

                Codes identifying names of simple observations.

                TypeCodeableConcept
                Summarytrue
                Requirements

                Knowing what kind of observation is being made is essential to understanding the observation.

                Alternate NamesName
                26. Observation.code.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

                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.

                Control10..*
                TypeCoding
                Summarytrue
                Requirements

                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ code
                • 28. Observation.code.coding:WoundObservableCode
                  Slice NameWoundObservableCode
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  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.

                  Control10..1*
                  TypeCoding
                  Summarytrue
                  Requirements

                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                  30. Observation.code.coding:WoundObservableCode.system
                  Definition

                  The identification of the code system that defines the meaning of the symbol in the code.

                  ShortIdentity of the terminology system
                  Comments

                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                  Control10..1
                  Typeuri
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be unambiguous about the source of the definition of the symbol.

                  Fixed Valuehttp://snomed.info/sct
                  32. Observation.code.coding:WoundObservableCode.code
                  Definition

                  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).

                  ShortSymbol in syntax defined by the system
                  Control10..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Fixed Value364554009
                  34. Observation.subject
                  Definition

                  The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.

                  ShortWho and/or what this is about
                  Comments

                  One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                  If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.

                  Control10..1
                  TypeReference(Group, Device, nl-core-location, nl-core-patient, Patient, Location)
                  Summarytrue
                  Requirements

                  Observations have no value if you don't know who or what they're about.

                  36. Observation.component
                  Definition

                  Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                  ShortComponent results
                  Comments

                  For a discussion on the ways Observations can be assembled in groups together see Notes below.

                  Control0..*
                  TypeBackboneElement
                  Summarytrue
                  Requirements

                  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.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • pattern @ code
                  • 38. Observation.component.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    ShortExtensions that cannot be ignored
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    40. Observation.component.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "code".

                    ShortType of component observation (code / type)
                    Control1..1
                    BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    42. Observation.component:WoundLength
                    Slice NameWoundLength
                    Definition

                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                    ShortComponent results
                    Comments

                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                    Control0..1*
                    TypeBackboneElement
                    Summarytrue
                    Requirements

                    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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    44. Observation.component:WoundLength.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    ShortExtensions that cannot be ignored
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    46. Observation.component:WoundLength.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "code".

                    ShortType of component observation (code / type)
                    Control1..1
                    BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://snomed.info/sct",
                        "code" : "401238003"
                      }]
                    }
                    48. Observation.component:WoundLength.value[x]:valueQuantity
                    Slice NamevalueQuantity
                    Definition

                    The length of the wound.


                    The information determined as a result of making the observation, if the information has a simple value.

                    ShortWoundLengthActual component result
                    Comments

                    Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                    Control0..1
                    TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Summarytrue
                    Requirements

                    An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                    Alternate NamesWondlengte
                    50. Observation.component:WoundWidth
                    Slice NameWoundWidth
                    Definition

                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                    ShortComponent results
                    Comments

                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                    Control0..1*
                    TypeBackboneElement
                    Summarytrue
                    Requirements

                    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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    52. Observation.component:WoundWidth.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    ShortExtensions that cannot be ignored
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    54. Observation.component:WoundWidth.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "code".

                    ShortType of component observation (code / type)
                    Control1..1
                    BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://snomed.info/sct",
                        "code" : "401239006"
                      }]
                    }
                    56. Observation.component:WoundWidth.code.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    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.

                    Control0..*
                    TypeCoding
                    Summarytrue
                    Requirements

                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                    Pattern Value{
                      "system" : "http://snomed.info/sct",
                      "code" : "401239006"
                    }
                    58. Observation.component:WoundWidth.code.coding.display
                    Definition

                    A representation of the meaning of the code in the system, following the rules of the system.

                    ShortRepresentation defined by the system
                    Control0..1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                    60. Observation.component:WoundWidth.value[x]:valueQuantity
                    Slice NamevalueQuantity
                    Definition

                    The width of the decubitus wound.


                    The information determined as a result of making the observation, if the information has a simple value.

                    ShortWoundWidthActual component result
                    Comments

                    Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                    Control0..1
                    TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Summarytrue
                    Requirements

                    An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                    Alternate NamesWondbreedte
                    62. Observation.component:WoundDepth
                    Slice NameWoundDepth
                    Definition

                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                    ShortComponent results
                    Comments

                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                    Control0..1*
                    TypeBackboneElement
                    Summarytrue
                    Requirements

                    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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    64. Observation.component:WoundDepth.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    ShortExtensions that cannot be ignored
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    66. Observation.component:WoundDepth.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "code".

                    ShortType of component observation (code / type)
                    Control1..1
                    BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://snomed.info/sct",
                        "code" : "425094009"
                      }]
                    }
                    68. Observation.component:WoundDepth.value[x]:valueQuantity
                    Slice NamevalueQuantity
                    Definition

                    The depth of the decubitus wound.


                    The information determined as a result of making the observation, if the information has a simple value.

                    ShortWoundDepthActual component result
                    Comments

                    Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                    Control0..1
                    TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Summarytrue
                    Requirements

                    An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                    Alternate NamesWonddiepte
                    70. Observation.component:WoundTissue
                    Slice NameWoundTissue
                    Definition

                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                    ShortComponent results
                    Comments

                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                    Control0..1*
                    TypeBackboneElement
                    Summarytrue
                    Requirements

                    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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    72. Observation.component:WoundTissue.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    ShortExtensions that cannot be ignored
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    74. Observation.component:WoundTissue.code
                    Definition

                    Describes what was observed. Sometimes this is called the observation "code".

                    ShortType of component observation (code / type)
                    Control1..1
                    BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

                    Knowing what kind of observation is being made is essential to understanding the observation.

                    Pattern Value{
                      "coding" : [{
                        "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                        "code" : "19.2.4"
                      }]
                    }
                    76. Observation.component:WoundTissue.value[x]
                    Definition

                    The information determined as a result of making the observation, if the information has a simple value.

                    ShortActual component result
                    Comments

                    Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                    Control10..1
                    TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Summarytrue
                    Requirements

                    An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                    SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 78. Observation.component:WoundTissue.value[x]:valueCodeableConcept
                      Slice NamevalueCodeableConcept
                      Definition

                      The information determined as a result of making the observation, if the information has a simple value.

                      ShortWoundTissueActual component result
                      Comments

                      Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                      Control10..1
                      TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Summarytrue
                      Requirements

                      An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                      Alternate NamesWondWeefsel
                      80. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

                      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.

                      Control0..1*
                      TypeCoding
                      Summarytrue
                      Requirements

                      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                      SlicingThis element introduces a set of slices on Observation.component.value[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ system
                      • 82. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue
                        Slice NameOncoUlcerCodelistValue
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        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.

                        Control0..1*
                        BindingThe codes SHALL be taken from For codes, see WondWeefselOncoUlcerCodelijst
                        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.2--20171231000000)

                        WondWeefselOncoUlcerCodelijst

                        TypeCoding
                        Summarytrue
                        Requirements

                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                        84. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                        Control10..1
                        Typeuri
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.1
                        86. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.code
                        Definition

                        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).

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        88. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue
                        Slice NameWCSCodelistValue
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        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.

                        Control0..1*
                        BindingThe codes SHALL be taken from For codes, see WondWeefselWCSCodelijst
                        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.1--20171231000000)

                        WondWeefselWCSCodelijst

                        TypeCoding
                        Summarytrue
                        Requirements

                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                        90. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.system
                        Definition

                        The identification of the code system that defines the meaning of the symbol in the code.

                        ShortIdentity of the terminology system
                        Comments

                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                        Control10..1
                        Typeuri
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be unambiguous about the source of the definition of the symbol.

                        Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.2
                        92. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.code
                        Definition

                        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).

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        94. Observation.component:WoundInfection
                        Slice NameWoundInfection
                        Definition

                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                        ShortComponent results
                        Comments

                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                        Control0..1*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

                        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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        96. Observation.component:WoundInfection.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        ShortExtensions that cannot be ignored
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                        Summarytrue
                        Alternate Namesextensions, user content, modifiers
                        98. Observation.component:WoundInfection.code
                        Definition

                        Describes what was observed. Sometimes this is called the observation "code".

                        ShortType of component observation (code / type)
                        Control1..1
                        BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Summarytrue
                        Requirements

                        Knowing what kind of observation is being made is essential to understanding the observation.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://snomed.info/sct",
                            "code" : "405009004"
                          }]
                        }
                        100. Observation.component:WoundInfection.code.coding
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        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.

                        Control0..1*
                        TypeCoding
                        Summarytrue
                        Requirements

                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                        102. Observation.component:WoundInfection.code.coding.display
                        Definition

                        A representation of the meaning of the code in the system, following the rules of the system.

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                        104. Observation.component:WoundInfection.value[x]:valueCodeableConcept
                        Slice NamevalueCodeableConcept
                        Definition

                        The information determined as a result of making the observation, if the information has a simple value.

                        ShortWoundInfectionActual component result
                        Comments

                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                        Control0..1
                        BindingThe codes SHALL be taken from For codes, see v2 Yes/no Indicator
                        (required to http://hl7.org/fhir/ValueSet/v2-0136)

                        v2 Yes/no Indicator

                        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Summarytrue
                        Requirements

                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                        Alternate NamesWondInfectie
                        106. Observation.component:WoundMoisture
                        Slice NameWoundMoisture
                        Definition

                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                        ShortComponent results
                        Comments

                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                        Control0..1*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

                        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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        108. Observation.component:WoundMoisture.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        ShortExtensions that cannot be ignored
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                        Summarytrue
                        Alternate Namesextensions, user content, modifiers
                        110. Observation.component:WoundMoisture.code
                        Definition

                        Describes what was observed. Sometimes this is called the observation "code".

                        ShortType of component observation (code / type)
                        Control1..1
                        BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Summarytrue
                        Requirements

                        Knowing what kind of observation is being made is essential to understanding the observation.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://snomed.info/sct",
                            "code" : "298007001"
                          }]
                        }
                        112. Observation.component:WoundMoisture.value[x]:valueCodeableConcept
                        Slice NamevalueCodeableConcept
                        Definition

                        Description of the moisture in the wound.


                        The information determined as a result of making the observation, if the information has a simple value.

                        ShortWoundMoistureActual component result
                        Comments

                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from For codes, see WondVochtigheidCodelijst
                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.3--20171231000000)

                        WondVochtigheidCodelijst

                        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Summarytrue
                        Requirements

                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                        Alternate NamesWondVochtigheid
                        114. Observation.component:WoundEdge
                        Slice NameWoundEdge
                        Definition

                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                        ShortComponent results
                        Comments

                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                        Control0..1*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

                        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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        116. Observation.component:WoundEdge.modifierExtension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                        ShortExtensions that cannot be ignored
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                        Summarytrue
                        Alternate Namesextensions, user content, modifiers
                        118. Observation.component:WoundEdge.code
                        Definition

                        Describes what was observed. Sometimes this is called the observation "code".

                        ShortType of component observation (code / type)
                        Control1..1
                        BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes
                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Summarytrue
                        Requirements

                        Knowing what kind of observation is being made is essential to understanding the observation.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://snomed.info/sct",
                            "code" : "449747006"
                          }]
                        }
                        120. Observation.component:WoundEdge.value[x]:valueCodeableConcept
                        Slice NamevalueCodeableConcept
                        Definition

                        Description of the condition of the outer edges of the wound.


                        The information determined as a result of making the observation, if the information has a simple value.

                        ShortWoundEdgeActual component result
                        Comments

                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from For codes, see WondRandCodelijst
                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.5--20171231000000)

                        WondRandCodelijst

                        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Summarytrue
                        Requirements

                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                        Alternate NamesWondRand

                        Guidance on how to interpret the contents of this table can be found here

                        0. Observation
                        Definition

                        Measurements and simple assertions made about a patient, device or other subject.

                        ShortMeasurements and simple assertions
                        Comments

                        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 lab reports, etc.

                        Control0..*
                        Alternate NamesVital Signs, Measurement, Results, Tests
                        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                        dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
                        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
                        obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
                        obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                        2. Observation.id
                        Definition

                        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                        ShortLogical id of this artifact
                        Comments

                        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                        Control0..1
                        Typeid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        4. Observation.meta
                        Definition

                        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

                        ShortMetadata about the resource
                        Control0..1
                        TypeMeta
                        Summarytrue
                        6. Observation.implicitRules
                        Definition

                        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

                        ShortA set of rules under which this content was created
                        Comments

                        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.

                        This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

                        Control0..1
                        Typeuri
                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        8. Observation.language
                        Definition

                        The base language in which the resource is written.

                        ShortLanguage of the resource content
                        Comments

                        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).

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from Common Languages
                        (extensible to http://hl7.org/fhir/ValueSet/languages)

                        A human language.

                        Additional BindingsPurpose
                        AllLanguagesMax Binding
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        10. Observation.text
                        Definition

                        A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "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.

                        ShortText summary of the resource, for human interpretation
                        Comments

                        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 in formation is added later.

                        Control0..1
                        This element is affected by the following invariants: dom-1
                        TypeNarrative
                        Alternate Namesnarrative, html, xhtml, display
                        12. Observation.contained
                        Definition

                        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.

                        ShortContained, inline Resources
                        Comments

                        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.

                        Control0..*
                        TypeResource
                        Alternate Namesinline resources, anonymous resources, contained resources
                        14. Observation.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control0..*
                        TypeExtension
                        SlicingThis element introduces a set of slices on Observation.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 16. Observation.extension:woundImage
                          Slice NamewoundImage
                          Definition

                          Optional Extension Element - found in all resources.

                          ShortOptional Extensions Element
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeExtension(WoundImage extension for Observation resources) (Extension Type: Attachment)
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          18. Observation.extension:woundImage.id
                          Definition

                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          20. Observation.extension:woundImage.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional Content defined by implementations
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on Observation.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 22. Observation.extension:woundImage.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                            Control1..1
                            Typeuri
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/observation-woundImage
                            24. Observation.extension:woundImage.value[x]
                            Definition

                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                            ShortValue of extension
                            Control0..1
                            TypeAttachment
                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                            SlicingThis element introduces a set of slices on Observation.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 26. Observation.extension:woundImage.value[x]:valueAttachment
                              Slice NamevalueAttachment
                              Definition

                              A photo of the wound.

                              ShortWoundImage
                              Control0..1
                              TypeAttachment
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Alternate NamesWondFoto
                              28. Observation.extension:reasonReference
                              Slice NamereasonReference
                              Definition

                              Indicates another resource whose existence justifies this event.

                              ShortWhy was event performed?
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Reason Reference) (Extension Type: Reference(Condition, Observation))
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              30. Observation.extension:reasonReference.id
                              Definition

                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              32. Observation.extension:reasonReference.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional Content defined by implementations
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Alternate Namesextensions, user content
                              SlicingThis element introduces a set of slices on Observation.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 34. Observation.extension:reasonReference.url
                                Definition

                                Source of the definition for the extension code - a logical name or a URL.

                                Shortidentifies the meaning of the extension
                                Comments

                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                Control1..1
                                Typeuri
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/event-reasonReference
                                36. Observation.extension:reasonReference.value[x]
                                Definition

                                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                ShortValue of extension
                                Control1..1
                                TypeReference(Condition, Observation, HCIM PressureUlcer, HCIM Wound)
                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                38. Observation.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                ShortExtensions that cannot be ignored
                                Comments

                                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.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                Alternate Namesextensions, user content
                                40. Observation.identifier
                                Definition

                                A unique identifier assigned to this observation.

                                ShortBusiness Identifier for observation
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..*
                                TypeIdentifier
                                Summarytrue
                                Requirements

                                Allows observations to be distinguished and referenced.

                                42. Observation.basedOn
                                Definition

                                A plan, proposal or order that is fulfilled in whole or in part by this event.

                                ShortFulfills plan, proposal or order
                                Control0..*
                                TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ProcedureRequest, ReferralRequest)
                                Summarytrue
                                Requirements

                                Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                                Alternate NamesFulfills
                                44. Observation.status
                                Definition

                                The status of the result value.

                                Shortregistered | preliminary | final | amended +
                                Comments

                                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                Control1..1
                                BindingThe codes SHALL be taken from ObservationStatus
                                (required to http://hl7.org/fhir/ValueSet/observation-status)

                                Codes providing the status of an observation.

                                Typecode
                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                                46. Observation.category
                                Definition

                                A code that classifies the general type of observation being made.

                                ShortClassification of type of observation
                                Comments

                                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.

                                Control0..*
                                BindingThe codes SHOULD be taken from Observation Category Codes
                                (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                                Codes for high level observation categories.

                                TypeCodeableConcept
                                Requirements

                                Used for filtering what observations are retrieved and displayed.

                                48. Observation.code
                                Definition

                                Describes what was observed. Sometimes this is called the observation "name".

                                ShortType of observation (code / type)
                                Control1..1
                                BindingFor example codes, see LOINC Codes
                                (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                Codes identifying names of simple observations.

                                TypeCodeableConcept
                                Summarytrue
                                Requirements

                                Knowing what kind of observation is being made is essential to understanding the observation.

                                Alternate NamesName
                                50. Observation.code.id
                                Definition

                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                Shortxml:id (or equivalent in JSON)
                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                52. Observation.code.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional Content defined by implementations
                                Comments

                                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.

                                Control0..*
                                TypeExtension
                                Alternate Namesextensions, user content
                                SlicingThis element introduces a set of slices on Observation.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 54. Observation.code.coding
                                  Definition

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

                                  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.

                                  Control1..*
                                  TypeCoding
                                  Summarytrue
                                  Requirements

                                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                  SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ code
                                  • 56. Observation.code.coding:WoundObservableCode
                                    Slice NameWoundObservableCode
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

                                    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.

                                    Control1..1
                                    TypeCoding
                                    Summarytrue
                                    Requirements

                                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                    58. Observation.code.coding:WoundObservableCode.id
                                    Definition

                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    Shortxml:id (or equivalent in JSON)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    60. Observation.code.coding:WoundObservableCode.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional Content defined by implementations
                                    Comments

                                    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.

                                    Control0..*
                                    TypeExtension
                                    Alternate Namesextensions, user content
                                    SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 62. Observation.code.coding:WoundObservableCode.system
                                      Definition

                                      The identification of the code system that defines the meaning of the symbol in the code.

                                      ShortIdentity of the terminology system
                                      Comments

                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                      Control1..1
                                      Typeuri
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be unambiguous about the source of the definition of the symbol.

                                      Fixed Valuehttp://snomed.info/sct
                                      64. Observation.code.coding:WoundObservableCode.version
                                      Definition

                                      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.

                                      ShortVersion of the system - if relevant
                                      Comments

                                      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.

                                      NoteThis is a business versionId, not a resource version id (see discussion)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      66. Observation.code.coding:WoundObservableCode.code
                                      Definition

                                      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).

                                      ShortSymbol in syntax defined by the system
                                      Control1..1
                                      Typecode
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to refer to a particular code in the system.

                                      Fixed Value364554009
                                      68. Observation.code.coding:WoundObservableCode.display
                                      Definition

                                      A representation of the meaning of the code in the system, following the rules of the system.

                                      ShortRepresentation defined by the system
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                      70. Observation.code.coding:WoundObservableCode.userSelected
                                      Definition

                                      Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                      ShortIf this coding was chosen directly by the user
                                      Comments

                                      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.

                                      Control0..1
                                      Typeboolean
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      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.

                                      72. Observation.code.text
                                      Definition

                                      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.

                                      ShortPlain text representation of the concept
                                      Comments

                                      Very often the text is the same as a displayName of one of the codings.

                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      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.

                                      74. Observation.subject
                                      Definition

                                      The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.

                                      ShortWho and/or what this is about
                                      Comments

                                      One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                                      If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.

                                      Control1..1
                                      TypeReference(Group, Device, nl-core-location, nl-core-patient)
                                      Summarytrue
                                      Requirements

                                      Observations have no value if you don't know who or what they're about.

                                      76. Observation.context
                                      Definition

                                      The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

                                      ShortHealthcare event during which this observation is made
                                      Comments

                                      This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).

                                      Control0..1
                                      TypeReference(nl-core-episodeofcare, HCIM Encounter, gp-Encounter)
                                      Requirements

                                      For some observations it may be important to know the link between an observation and a particular encounter.

                                      Alternate NamesEncounter
                                      78. Observation.effective[x]
                                      Definition

                                      The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

                                      ShortClinically relevant time/time-period for observation
                                      Comments

                                      At least a date should be present unless this observation is a historical report.

                                      Control0..1
                                      TypeChoice of: dateTime, Period
                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                                      Alternate NamesOccurrence
                                      80. Observation.issued
                                      Definition

                                      The date and time this observation was made available to providers, typically after the results have been reviewed and verified.

                                      ShortDate/Time this was made available
                                      Comments

                                      Updated when the result is updated.

                                      Control0..1
                                      Typeinstant
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      82. Observation.performer
                                      Definition

                                      Who was responsible for asserting the observed value as "true".

                                      ShortWho is responsible for the observation
                                      Control0..*
                                      TypeReference(nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                                      Summarytrue
                                      Requirements

                                      May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

                                      84. Observation.performer.id
                                      Definition

                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      86. Observation.performer.extension
                                      Definition

                                      An Extension

                                      ShortExtension
                                      Control0..*
                                      TypeExtension
                                      SlicingThis element introduces a set of slices on Observation.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 88. Observation.performer.extension:practitionerRole
                                        Slice NamepractitionerRole
                                        Definition

                                        Optional Extension Element - found in all resources.

                                        ShortOptional Extensions Element
                                        Control0..1
                                        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                        90. Observation.performer.reference
                                        Definition

                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                        ShortLiteral reference, Relative, internal or absolute URL
                                        Comments

                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                        Control0..1
                                        This element is affected by the following invariants: ref-1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        92. Observation.performer.identifier
                                        Definition

                                        An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                        ShortLogical reference, when literal reference is not known
                                        Comments

                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                        Control0..1
                                        TypeIdentifier
                                        Summarytrue
                                        94. Observation.performer.display
                                        Definition

                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                        ShortText alternative for the resource
                                        Comments

                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        96. Observation.value[x]
                                        Definition

                                        The information determined as a result of making the observation, if the information has a simple value.

                                        ShortActual result
                                        Comments

                                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

                                        If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.

                                        Control0..1
                                        This element is affected by the following invariants: obs-7
                                        TypeChoice of: Quantity, CodeableConcept, string, boolean, Range, Ratio, SampledData, Attachment, time, dateTime, Period
                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                        98. Observation.dataAbsentReason
                                        Definition

                                        Provides a reason why the expected value in the element Observation.value[x] is missing.

                                        ShortWhy the result is missing
                                        Comments

                                        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.

                                        Control0..1
                                        This element is affected by the following invariants: obs-6
                                        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                        Codes specifying why the result (Observation.value[x]) is missing.

                                        TypeCodeableConcept
                                        Requirements

                                        For many results it is necessary to handle exceptional values in measurements.

                                        100. Observation.interpretation
                                        Definition

                                        The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                        ShortHigh, low, normal, etc.
                                        Control0..1
                                        BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                        (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                        Codes identifying interpretations of observations.

                                        TypeCodeableConcept
                                        Requirements

                                        For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                        Alternate NamesAbnormal Flag
                                        102. Observation.comment
                                        Definition

                                        May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result.

                                        ShortComments about result
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Requirements

                                        Need to be able to provide free text additional information.

                                        104. Observation.bodySite
                                        Definition

                                        Indicates the site on the subject's body where the observation was made (i.e. the target site).

                                        ShortObserved body part
                                        Comments

                                        Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance.

                                        Control0..1
                                        BindingFor example codes, see SNOMED CT Body Structures
                                        (example to http://hl7.org/fhir/ValueSet/body-site)

                                        Codes describing anatomical locations. May include laterality.

                                        TypeCodeableConcept
                                        106. Observation.method
                                        Definition

                                        Indicates the mechanism used to perform the observation.

                                        ShortHow it was done
                                        Comments

                                        Only used if not implicit in code for Observation.code.

                                        Control0..1
                                        BindingFor example codes, see Observation Methods
                                        (example to http://hl7.org/fhir/ValueSet/observation-methods)

                                        Methods for simple observations.

                                        TypeCodeableConcept
                                        Requirements

                                        In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                                        108. Observation.specimen
                                        Definition

                                        The specimen that was used when this observation was made.

                                        ShortSpecimen used for this observation
                                        Comments

                                        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).

                                        Control0..1
                                        TypeReference(Specimen)
                                        110. Observation.device
                                        Definition

                                        The device used to generate the observation data.

                                        Short(Measurement) Device
                                        Comments

                                        An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.

                                        Control0..1
                                        TypeReference(Device, DeviceMetric)
                                        112. Observation.referenceRange
                                        Definition

                                        Guidance on how to interpret the value by comparison to a normal or recommended range.

                                        ShortProvides guide for interpretation
                                        Comments

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

                                        Control0..*
                                        TypeBackboneElement
                                        Requirements

                                        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.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                        obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                        114. Observation.referenceRange.id
                                        Definition

                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        116. Observation.referenceRange.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional Content defined by implementations
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Alternate Namesextensions, user content
                                        118. Observation.referenceRange.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        ShortExtensions that cannot be ignored
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                        Summarytrue
                                        Alternate Namesextensions, user content, modifiers
                                        120. Observation.referenceRange.low
                                        Definition

                                        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).

                                        ShortLow Range, if relevant
                                        Control0..1
                                        This element is affected by the following invariants: obs-3
                                        TypeQuantity(SimpleQuantity)
                                        122. Observation.referenceRange.high
                                        Definition

                                        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).

                                        ShortHigh Range, if relevant
                                        Control0..1
                                        This element is affected by the following invariants: obs-3
                                        TypeQuantity(SimpleQuantity)
                                        124. Observation.referenceRange.type
                                        Definition

                                        Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

                                        ShortReference range qualifier
                                        Comments

                                        This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

                                        Control0..1
                                        BindingUnless not suitable, these codes SHALL be taken from Observation Reference Range Meaning Codes
                                        (extensible to http://hl7.org/fhir/ValueSet/referencerange-meaning)

                                        Code for the meaning of a reference range.

                                        TypeCodeableConcept
                                        Requirements

                                        Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation.

                                        126. Observation.referenceRange.appliesTo
                                        Definition

                                        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.

                                        ShortReference range population
                                        Comments

                                        This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

                                        Control0..*
                                        BindingFor example codes, see Observation Reference Range Applies To Codes
                                        (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto)

                                        Codes identifying the population the reference range applies to.

                                        TypeCodeableConcept
                                        Requirements

                                        Need to be able to identify the target population for proper interpretation.

                                        128. Observation.referenceRange.age
                                        Definition

                                        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.

                                        ShortApplicable age range, if relevant
                                        Control0..1
                                        TypeRange
                                        Requirements

                                        Some analytes vary greatly over age.

                                        130. Observation.referenceRange.text
                                        Definition

                                        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'.

                                        ShortText based reference range in an observation
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        132. Observation.related
                                        Definition

                                        A reference to another resource (usually another Observation) whose relationship is defined by the relationship type code.

                                        ShortResource related to this observation
                                        Comments

                                        For a discussion on the ways Observations can assembled in groups together see Notes below.

                                        Control0..*
                                        TypeBackboneElement
                                        Summarytrue
                                        Requirements

                                        Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                        134. Observation.related.id
                                        Definition

                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        136. Observation.related.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional Content defined by implementations
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Alternate Namesextensions, user content
                                        138. Observation.related.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        ShortExtensions that cannot be ignored
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                        Summarytrue
                                        Alternate Namesextensions, user content, modifiers
                                        140. Observation.related.type
                                        Definition

                                        A code specifying the kind of relationship that exists with the target resource.

                                        Shorthas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
                                        Comments

                                        The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.

                                        Control0..1
                                        BindingThe codes SHALL be taken from ObservationRelationshipType
                                        (required to http://hl7.org/fhir/ValueSet/observation-relationshiptypes)

                                        Codes specifying how two observations are related.

                                        Typecode
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Requirements

                                        A relationship type SHOULD be provided.

                                        142. Observation.related.target
                                        Definition

                                        A reference to the observation or QuestionnaireResponse resource that is related to this observation.

                                        ShortResource that is related to this one
                                        Control1..1
                                        TypeReference(Observation, QuestionnaireResponse, Sequence)
                                        144. Observation.component
                                        Definition

                                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                        ShortComponent results
                                        Comments

                                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                        Control0..*
                                        TypeBackboneElement
                                        Summarytrue
                                        Requirements

                                        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.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • pattern @ code
                                        • 146. Observation.component.id
                                          Definition

                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          148. Observation.component.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional Content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          150. Observation.component.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          ShortExtensions that cannot be ignored
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                          Summarytrue
                                          Alternate Namesextensions, user content, modifiers
                                          152. Observation.component.code
                                          Definition

                                          Describes what was observed. Sometimes this is called the observation "code".

                                          ShortType of component observation (code / type)
                                          Control1..1
                                          BindingFor example codes, see LOINC Codes
                                          (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                          Codes identifying names of simple observations.

                                          TypeCodeableConcept
                                          Summarytrue
                                          Requirements

                                          Knowing what kind of observation is being made is essential to understanding the observation.

                                          154. Observation.component.value[x]
                                          Definition

                                          The information determined as a result of making the observation, if the information has a simple value.

                                          ShortActual component result
                                          Comments

                                          Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                          Control0..1
                                          TypeChoice of: Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period
                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                          156. Observation.component.dataAbsentReason
                                          Definition

                                          Provides a reason why the expected value in the element Observation.value[x] is missing.

                                          ShortWhy the component result is missing
                                          Comments

                                          "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.

                                          Control0..1
                                          This element is affected by the following invariants: obs-6
                                          BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                          (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                          Codes specifying why the result (Observation.value[x]) is missing.

                                          TypeCodeableConcept
                                          Requirements

                                          For many results it is necessary to handle exceptional values in measurements.

                                          158. Observation.component.interpretation
                                          Definition

                                          The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                          ShortHigh, low, normal, etc.
                                          Comments

                                          The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                          Control0..1
                                          BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                          (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                          Codes identifying interpretations of observations.

                                          TypeCodeableConcept
                                          Requirements

                                          For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                          Alternate NamesAbnormal Flag
                                          160. Observation.component.referenceRange
                                          Definition

                                          Guidance on how to interpret the value by comparison to a normal or recommended range.

                                          ShortProvides guide for interpretation of component result
                                          Comments

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

                                          Control0..*
                                          TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                          Requirements

                                          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.

                                          162. Observation.component:WoundLength
                                          Slice NameWoundLength
                                          Definition

                                          Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                          ShortComponent results
                                          Comments

                                          For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                          Control0..1
                                          TypeBackboneElement
                                          Summarytrue
                                          Requirements

                                          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.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                          164. Observation.component:WoundLength.id
                                          Definition

                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          166. Observation.component:WoundLength.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional Content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          168. Observation.component:WoundLength.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          ShortExtensions that cannot be ignored
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                          Summarytrue
                                          Alternate Namesextensions, user content, modifiers
                                          170. Observation.component:WoundLength.code
                                          Definition

                                          Describes what was observed. Sometimes this is called the observation "code".

                                          ShortType of component observation (code / type)
                                          Control1..1
                                          BindingFor example codes, see LOINC Codes
                                          (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                          Codes identifying names of simple observations.

                                          TypeCodeableConcept
                                          Summarytrue
                                          Requirements

                                          Knowing what kind of observation is being made is essential to understanding the observation.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://snomed.info/sct",
                                              "code" : "401238003"
                                            }]
                                          }
                                          172. Observation.component:WoundLength.code.id
                                          Definition

                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          174. Observation.component:WoundLength.code.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional Content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 176. Observation.component:WoundLength.code.coding
                                            Definition

                                            A reference to a code defined by a terminology system.

                                            ShortCode defined by a terminology system
                                            Comments

                                            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.

                                            Control0..*
                                            TypeCoding
                                            Summarytrue
                                            Requirements

                                            Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                            178. Observation.component:WoundLength.code.coding.id
                                            Definition

                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            180. Observation.component:WoundLength.code.coding.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional Content defined by implementations
                                            Comments

                                            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.

                                            Control0..*
                                            TypeExtension
                                            Alternate Namesextensions, user content
                                            SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 182. Observation.component:WoundLength.code.coding.system
                                              Definition

                                              The identification of the code system that defines the meaning of the symbol in the code.

                                              ShortIdentity of the terminology system
                                              Comments

                                              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                              Control0..1
                                              Typeuri
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to be unambiguous about the source of the definition of the symbol.

                                              184. Observation.component:WoundLength.code.coding.version
                                              Definition

                                              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.

                                              ShortVersion of the system - if relevant
                                              Comments

                                              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.

                                              NoteThis is a business versionId, not a resource version id (see discussion)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              186. Observation.component:WoundLength.code.coding.code
                                              Definition

                                              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).

                                              ShortSymbol in syntax defined by the system
                                              Control0..1
                                              Typecode
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to refer to a particular code in the system.

                                              188. Observation.component:WoundLength.code.coding.display
                                              Definition

                                              A representation of the meaning of the code in the system, following the rules of the system.

                                              ShortRepresentation defined by the system
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                              190. Observation.component:WoundLength.code.coding.userSelected
                                              Definition

                                              Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                              ShortIf this coding was chosen directly by the user
                                              Comments

                                              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.

                                              Control0..1
                                              Typeboolean
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              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.

                                              192. Observation.component:WoundLength.code.text
                                              Definition

                                              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.

                                              ShortPlain text representation of the concept
                                              Comments

                                              Very often the text is the same as a displayName of one of the codings.

                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

                                              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.

                                              194. Observation.component:WoundLength.value[x]:valueQuantity
                                              Slice NamevalueQuantity
                                              Definition

                                              The length of the wound.

                                              ShortWoundLength
                                              Comments

                                              Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                              Control0..1
                                              TypeQuantity
                                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                                              Summarytrue
                                              Requirements

                                              An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                              Alternate NamesWondlengte
                                              196. Observation.component:WoundLength.dataAbsentReason
                                              Definition

                                              Provides a reason why the expected value in the element Observation.value[x] is missing.

                                              ShortWhy the component result is missing
                                              Comments

                                              "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.

                                              Control0..1
                                              This element is affected by the following invariants: obs-6
                                              BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                              (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                              Codes specifying why the result (Observation.value[x]) is missing.

                                              TypeCodeableConcept
                                              Requirements

                                              For many results it is necessary to handle exceptional values in measurements.

                                              198. Observation.component:WoundLength.interpretation
                                              Definition

                                              The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                              ShortHigh, low, normal, etc.
                                              Comments

                                              The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                              Control0..1
                                              BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                              (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                              Codes identifying interpretations of observations.

                                              TypeCodeableConcept
                                              Requirements

                                              For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                              Alternate NamesAbnormal Flag
                                              200. Observation.component:WoundLength.referenceRange
                                              Definition

                                              Guidance on how to interpret the value by comparison to a normal or recommended range.

                                              ShortProvides guide for interpretation of component result
                                              Comments

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

                                              Control0..*
                                              TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                              Requirements

                                              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.

                                              202. Observation.component:WoundWidth
                                              Slice NameWoundWidth
                                              Definition

                                              Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                              ShortComponent results
                                              Comments

                                              For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                              Control0..1
                                              TypeBackboneElement
                                              Summarytrue
                                              Requirements

                                              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.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                              204. Observation.component:WoundWidth.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              206. Observation.component:WoundWidth.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional Content defined by implementations
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              208. Observation.component:WoundWidth.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              ShortExtensions that cannot be ignored
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                              Summarytrue
                                              Alternate Namesextensions, user content, modifiers
                                              210. Observation.component:WoundWidth.code
                                              Definition

                                              Describes what was observed. Sometimes this is called the observation "code".

                                              ShortType of component observation (code / type)
                                              Control1..1
                                              BindingFor example codes, see LOINC Codes
                                              (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                              Codes identifying names of simple observations.

                                              TypeCodeableConcept
                                              Summarytrue
                                              Requirements

                                              Knowing what kind of observation is being made is essential to understanding the observation.

                                              Pattern Value{
                                                "coding" : [{
                                                  "system" : "http://snomed.info/sct",
                                                  "code" : "401239006"
                                                }]
                                              }
                                              212. Observation.component:WoundWidth.code.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              214. Observation.component:WoundWidth.code.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional Content defined by implementations
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 216. Observation.component:WoundWidth.code.coding
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

                                                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.

                                                Control0..*
                                                TypeCoding
                                                Summarytrue
                                                Requirements

                                                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                Pattern Value{
                                                  "system" : "http://snomed.info/sct",
                                                  "code" : "401239006"
                                                }
                                                218. Observation.component:WoundWidth.code.coding.id
                                                Definition

                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                Shortxml:id (or equivalent in JSON)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                220. Observation.component:WoundWidth.code.coding.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional Content defined by implementations
                                                Comments

                                                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.

                                                Control0..*
                                                TypeExtension
                                                Alternate Namesextensions, user content
                                                SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 222. Observation.component:WoundWidth.code.coding.system
                                                  Definition

                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                  ShortIdentity of the terminology system
                                                  Comments

                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                  Control0..1
                                                  Typeuri
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                  224. Observation.component:WoundWidth.code.coding.version
                                                  Definition

                                                  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.

                                                  ShortVersion of the system - if relevant
                                                  Comments

                                                  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.

                                                  NoteThis is a business versionId, not a resource version id (see discussion)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  226. Observation.component:WoundWidth.code.coding.code
                                                  Definition

                                                  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).

                                                  ShortSymbol in syntax defined by the system
                                                  Control0..1
                                                  Typecode
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to refer to a particular code in the system.

                                                  228. Observation.component:WoundWidth.code.coding.display
                                                  Definition

                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                  ShortRepresentation defined by the system
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                  230. Observation.component:WoundWidth.code.coding.userSelected
                                                  Definition

                                                  Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                  ShortIf this coding was chosen directly by the user
                                                  Comments

                                                  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.

                                                  Control0..1
                                                  Typeboolean
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  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.

                                                  232. Observation.component:WoundWidth.code.text
                                                  Definition

                                                  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.

                                                  ShortPlain text representation of the concept
                                                  Comments

                                                  Very often the text is the same as a displayName of one of the codings.

                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  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.

                                                  234. Observation.component:WoundWidth.value[x]:valueQuantity
                                                  Slice NamevalueQuantity
                                                  Definition

                                                  The width of the decubitus wound.

                                                  ShortWoundWidth
                                                  Comments

                                                  Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                  Control0..1
                                                  TypeQuantity
                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                  Summarytrue
                                                  Requirements

                                                  An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                  Alternate NamesWondbreedte
                                                  236. Observation.component:WoundWidth.dataAbsentReason
                                                  Definition

                                                  Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                  ShortWhy the component result is missing
                                                  Comments

                                                  "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.

                                                  Control0..1
                                                  This element is affected by the following invariants: obs-6
                                                  BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                  (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                  Codes specifying why the result (Observation.value[x]) is missing.

                                                  TypeCodeableConcept
                                                  Requirements

                                                  For many results it is necessary to handle exceptional values in measurements.

                                                  238. Observation.component:WoundWidth.interpretation
                                                  Definition

                                                  The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                  ShortHigh, low, normal, etc.
                                                  Comments

                                                  The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                  (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                  Codes identifying interpretations of observations.

                                                  TypeCodeableConcept
                                                  Requirements

                                                  For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                  Alternate NamesAbnormal Flag
                                                  240. Observation.component:WoundWidth.referenceRange
                                                  Definition

                                                  Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                  ShortProvides guide for interpretation of component result
                                                  Comments

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

                                                  Control0..*
                                                  TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                  Requirements

                                                  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.

                                                  242. Observation.component:WoundDepth
                                                  Slice NameWoundDepth
                                                  Definition

                                                  Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                  ShortComponent results
                                                  Comments

                                                  For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                  Control0..1
                                                  TypeBackboneElement
                                                  Summarytrue
                                                  Requirements

                                                  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.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                  244. Observation.component:WoundDepth.id
                                                  Definition

                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  246. Observation.component:WoundDepth.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional Content defined by implementations
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Alternate Namesextensions, user content
                                                  248. Observation.component:WoundDepth.modifierExtension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                  ShortExtensions that cannot be ignored
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                  Summarytrue
                                                  Alternate Namesextensions, user content, modifiers
                                                  250. Observation.component:WoundDepth.code
                                                  Definition

                                                  Describes what was observed. Sometimes this is called the observation "code".

                                                  ShortType of component observation (code / type)
                                                  Control1..1
                                                  BindingFor example codes, see LOINC Codes
                                                  (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                  Codes identifying names of simple observations.

                                                  TypeCodeableConcept
                                                  Summarytrue
                                                  Requirements

                                                  Knowing what kind of observation is being made is essential to understanding the observation.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://snomed.info/sct",
                                                      "code" : "425094009"
                                                    }]
                                                  }
                                                  252. Observation.component:WoundDepth.code.id
                                                  Definition

                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  254. Observation.component:WoundDepth.code.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional Content defined by implementations
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Alternate Namesextensions, user content
                                                  SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 256. Observation.component:WoundDepth.code.coding
                                                    Definition

                                                    A reference to a code defined by a terminology system.

                                                    ShortCode defined by a terminology system
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeCoding
                                                    Summarytrue
                                                    Requirements

                                                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                    258. Observation.component:WoundDepth.code.coding.id
                                                    Definition

                                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    260. Observation.component:WoundDepth.code.coding.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional Content defined by implementations
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeExtension
                                                    Alternate Namesextensions, user content
                                                    SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 262. Observation.component:WoundDepth.code.coding.system
                                                      Definition

                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                      ShortIdentity of the terminology system
                                                      Comments

                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                      Control0..1
                                                      Typeuri
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                      264. Observation.component:WoundDepth.code.coding.version
                                                      Definition

                                                      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.

                                                      ShortVersion of the system - if relevant
                                                      Comments

                                                      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.

                                                      NoteThis is a business versionId, not a resource version id (see discussion)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      266. Observation.component:WoundDepth.code.coding.code
                                                      Definition

                                                      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).

                                                      ShortSymbol in syntax defined by the system
                                                      Control0..1
                                                      Typecode
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Need to refer to a particular code in the system.

                                                      268. Observation.component:WoundDepth.code.coding.display
                                                      Definition

                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                      ShortRepresentation defined by the system
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                      270. Observation.component:WoundDepth.code.coding.userSelected
                                                      Definition

                                                      Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                      ShortIf this coding was chosen directly by the user
                                                      Comments

                                                      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.

                                                      Control0..1
                                                      Typeboolean
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      272. Observation.component:WoundDepth.code.text
                                                      Definition

                                                      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.

                                                      ShortPlain text representation of the concept
                                                      Comments

                                                      Very often the text is the same as a displayName of one of the codings.

                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      274. Observation.component:WoundDepth.value[x]:valueQuantity
                                                      Slice NamevalueQuantity
                                                      Definition

                                                      The depth of the decubitus wound.

                                                      ShortWoundDepth
                                                      Comments

                                                      Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                      Control0..1
                                                      TypeQuantity
                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                      Summarytrue
                                                      Requirements

                                                      An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                      Alternate NamesWonddiepte
                                                      276. Observation.component:WoundDepth.dataAbsentReason
                                                      Definition

                                                      Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                      ShortWhy the component result is missing
                                                      Comments

                                                      "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.

                                                      Control0..1
                                                      This element is affected by the following invariants: obs-6
                                                      BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                      Codes specifying why the result (Observation.value[x]) is missing.

                                                      TypeCodeableConcept
                                                      Requirements

                                                      For many results it is necessary to handle exceptional values in measurements.

                                                      278. Observation.component:WoundDepth.interpretation
                                                      Definition

                                                      The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                      ShortHigh, low, normal, etc.
                                                      Comments

                                                      The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                      Codes identifying interpretations of observations.

                                                      TypeCodeableConcept
                                                      Requirements

                                                      For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                      Alternate NamesAbnormal Flag
                                                      280. Observation.component:WoundDepth.referenceRange
                                                      Definition

                                                      Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                      ShortProvides guide for interpretation of component result
                                                      Comments

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

                                                      Control0..*
                                                      TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                      Requirements

                                                      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.

                                                      282. Observation.component:WoundTissue
                                                      Slice NameWoundTissue
                                                      Definition

                                                      Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                      ShortComponent results
                                                      Comments

                                                      For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                      Control0..1
                                                      TypeBackboneElement
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                      284. Observation.component:WoundTissue.id
                                                      Definition

                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      Shortxml:id (or equivalent in JSON)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      286. Observation.component:WoundTissue.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional Content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Alternate Namesextensions, user content
                                                      288. Observation.component:WoundTissue.modifierExtension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                      ShortExtensions that cannot be ignored
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                      Summarytrue
                                                      Alternate Namesextensions, user content, modifiers
                                                      290. Observation.component:WoundTissue.code
                                                      Definition

                                                      Describes what was observed. Sometimes this is called the observation "code".

                                                      ShortType of component observation (code / type)
                                                      Control1..1
                                                      BindingFor example codes, see LOINC Codes
                                                      (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                      Codes identifying names of simple observations.

                                                      TypeCodeableConcept
                                                      Summarytrue
                                                      Requirements

                                                      Knowing what kind of observation is being made is essential to understanding the observation.

                                                      Pattern Value{
                                                        "coding" : [{
                                                          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                          "code" : "19.2.4"
                                                        }]
                                                      }
                                                      292. Observation.component:WoundTissue.code.id
                                                      Definition

                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      Shortxml:id (or equivalent in JSON)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      294. Observation.component:WoundTissue.code.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional Content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Alternate Namesextensions, user content
                                                      SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 296. Observation.component:WoundTissue.code.coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        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.

                                                        Control0..*
                                                        TypeCoding
                                                        Summarytrue
                                                        Requirements

                                                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                        298. Observation.component:WoundTissue.code.coding.id
                                                        Definition

                                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                        Shortxml:id (or equivalent in JSON)
                                                        Control0..1
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        300. Observation.component:WoundTissue.code.coding.extension
                                                        Definition

                                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                        ShortAdditional Content defined by implementations
                                                        Comments

                                                        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.

                                                        Control0..*
                                                        TypeExtension
                                                        Alternate Namesextensions, user content
                                                        SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 302. Observation.component:WoundTissue.code.coding.system
                                                          Definition

                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                          ShortIdentity of the terminology system
                                                          Comments

                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                          Control0..1
                                                          Typeuri
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                          304. Observation.component:WoundTissue.code.coding.version
                                                          Definition

                                                          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.

                                                          ShortVersion of the system - if relevant
                                                          Comments

                                                          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.

                                                          NoteThis is a business versionId, not a resource version id (see discussion)
                                                          Control0..1
                                                          Typestring
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          306. Observation.component:WoundTissue.code.coding.code
                                                          Definition

                                                          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).

                                                          ShortSymbol in syntax defined by the system
                                                          Control0..1
                                                          Typecode
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to refer to a particular code in the system.

                                                          308. Observation.component:WoundTissue.code.coding.display
                                                          Definition

                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                          ShortRepresentation defined by the system
                                                          Control0..1
                                                          Typestring
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                          310. Observation.component:WoundTissue.code.coding.userSelected
                                                          Definition

                                                          Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                          ShortIf this coding was chosen directly by the user
                                                          Comments

                                                          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.

                                                          Control0..1
                                                          Typeboolean
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          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.

                                                          312. Observation.component:WoundTissue.code.text
                                                          Definition

                                                          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.

                                                          ShortPlain text representation of the concept
                                                          Comments

                                                          Very often the text is the same as a displayName of one of the codings.

                                                          Control0..1
                                                          Typestring
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          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.

                                                          314. Observation.component:WoundTissue.value[x]
                                                          Definition

                                                          The information determined as a result of making the observation, if the information has a simple value.

                                                          ShortActual component result
                                                          Comments

                                                          Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                          Control1..1
                                                          TypeCodeableConcept
                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                          Summarytrue
                                                          Requirements

                                                          An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                          SlicingThis element introduces a set of slices on Observation.component.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                          • type @ $this
                                                          • 316. Observation.component:WoundTissue.value[x]:valueCodeableConcept
                                                            Slice NamevalueCodeableConcept
                                                            Definition

                                                            The information determined as a result of making the observation, if the information has a simple value.

                                                            ShortWoundTissue
                                                            Comments

                                                            Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                            Control1..1
                                                            TypeCodeableConcept
                                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                            Summarytrue
                                                            Requirements

                                                            An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                            Alternate NamesWondWeefsel
                                                            318. Observation.component:WoundTissue.value[x]:valueCodeableConcept.id
                                                            Definition

                                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                            Shortxml:id (or equivalent in JSON)
                                                            Control0..1
                                                            Typestring
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            320. Observation.component:WoundTissue.value[x]:valueCodeableConcept.extension
                                                            Definition

                                                            May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                            ShortAdditional Content defined by implementations
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Alternate Namesextensions, user content
                                                            SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 322. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding
                                                              Definition

                                                              A reference to a code defined by a terminology system.

                                                              ShortCode defined by a terminology system
                                                              Comments

                                                              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.

                                                              Control0..1
                                                              TypeCoding
                                                              Summarytrue
                                                              Requirements

                                                              Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ system
                                                              • 324. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue
                                                                Slice NameOncoUlcerCodelistValue
                                                                Definition

                                                                A reference to a code defined by a terminology system.

                                                                ShortCode defined by a terminology system
                                                                Comments

                                                                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.

                                                                Control0..1
                                                                BindingThe codes SHALL be taken from WondWeefselOncoUlcerCodelijst
                                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.2--20171231000000)

                                                                WondWeefselOncoUlcerCodelijst

                                                                TypeCoding
                                                                Summarytrue
                                                                Requirements

                                                                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                                326. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.id
                                                                Definition

                                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                Shortxml:id (or equivalent in JSON)
                                                                Control0..1
                                                                Typestring
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                328. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.extension
                                                                Definition

                                                                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                ShortAdditional Content defined by implementations
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Alternate Namesextensions, user content
                                                                SlicingThis element introduces a set of slices on Observation.component.value[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 330. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.system
                                                                  Definition

                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                  ShortIdentity of the terminology system
                                                                  Comments

                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                                  Control1..1
                                                                  Typeuri
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                  Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.1
                                                                  332. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.version
                                                                  Definition

                                                                  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.

                                                                  ShortVersion of the system - if relevant
                                                                  Comments

                                                                  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.

                                                                  NoteThis is a business versionId, not a resource version id (see discussion)
                                                                  Control0..1
                                                                  Typestring
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  334. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.code
                                                                  Definition

                                                                  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).

                                                                  ShortSymbol in syntax defined by the system
                                                                  Control1..1
                                                                  Typecode
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to refer to a particular code in the system.

                                                                  336. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.display
                                                                  Definition

                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                  ShortRepresentation defined by the system
                                                                  Control0..1
                                                                  Typestring
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                  338. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:OncoUlcerCodelistValue.userSelected
                                                                  Definition

                                                                  Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                                  ShortIf this coding was chosen directly by the user
                                                                  Comments

                                                                  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.

                                                                  Control0..1
                                                                  Typeboolean
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  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.

                                                                  340. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue
                                                                  Slice NameWCSCodelistValue
                                                                  Definition

                                                                  A reference to a code defined by a terminology system.

                                                                  ShortCode defined by a terminology system
                                                                  Comments

                                                                  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.

                                                                  Control0..1
                                                                  BindingThe codes SHALL be taken from WondWeefselWCSCodelijst
                                                                  (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.1--20171231000000)

                                                                  WondWeefselWCSCodelijst

                                                                  TypeCoding
                                                                  Summarytrue
                                                                  Requirements

                                                                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                                  342. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.id
                                                                  Definition

                                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  Shortxml:id (or equivalent in JSON)
                                                                  Control0..1
                                                                  Typestring
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  344. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.extension
                                                                  Definition

                                                                  May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                  ShortAdditional Content defined by implementations
                                                                  Comments

                                                                  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.

                                                                  Control0..*
                                                                  TypeExtension
                                                                  Alternate Namesextensions, user content
                                                                  SlicingThis element introduces a set of slices on Observation.component.value[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 346. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.system
                                                                    Definition

                                                                    The identification of the code system that defines the meaning of the symbol in the code.

                                                                    ShortIdentity of the terminology system
                                                                    Comments

                                                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                                    Control1..1
                                                                    Typeuri
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to be unambiguous about the source of the definition of the symbol.

                                                                    Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.7.2
                                                                    348. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.version
                                                                    Definition

                                                                    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.

                                                                    ShortVersion of the system - if relevant
                                                                    Comments

                                                                    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.

                                                                    NoteThis is a business versionId, not a resource version id (see discussion)
                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    350. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.code
                                                                    Definition

                                                                    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).

                                                                    ShortSymbol in syntax defined by the system
                                                                    Control1..1
                                                                    Typecode
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to refer to a particular code in the system.

                                                                    352. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.display
                                                                    Definition

                                                                    A representation of the meaning of the code in the system, following the rules of the system.

                                                                    ShortRepresentation defined by the system
                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                    354. Observation.component:WoundTissue.value[x]:valueCodeableConcept.coding:WCSCodelistValue.userSelected
                                                                    Definition

                                                                    Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                                    ShortIf this coding was chosen directly by the user
                                                                    Comments

                                                                    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.

                                                                    Control0..1
                                                                    Typeboolean
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    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.

                                                                    356. Observation.component:WoundTissue.value[x]:valueCodeableConcept.text
                                                                    Definition

                                                                    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.

                                                                    ShortPlain text representation of the concept
                                                                    Comments

                                                                    Very often the text is the same as a displayName of one of the codings.

                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

                                                                    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.

                                                                    358. Observation.component:WoundTissue.dataAbsentReason
                                                                    Definition

                                                                    Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                                    ShortWhy the component result is missing
                                                                    Comments

                                                                    "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.

                                                                    Control0..1
                                                                    This element is affected by the following invariants: obs-6
                                                                    BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                                    (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                                    Codes specifying why the result (Observation.value[x]) is missing.

                                                                    TypeCodeableConcept
                                                                    Requirements

                                                                    For many results it is necessary to handle exceptional values in measurements.

                                                                    360. Observation.component:WoundTissue.interpretation
                                                                    Definition

                                                                    The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                                    ShortHigh, low, normal, etc.
                                                                    Comments

                                                                    The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                                    Control0..1
                                                                    BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                                    (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                    Codes identifying interpretations of observations.

                                                                    TypeCodeableConcept
                                                                    Requirements

                                                                    For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                    Alternate NamesAbnormal Flag
                                                                    362. Observation.component:WoundTissue.referenceRange
                                                                    Definition

                                                                    Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                    ShortProvides guide for interpretation of component result
                                                                    Comments

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

                                                                    Control0..*
                                                                    TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                    Requirements

                                                                    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.

                                                                    364. Observation.component:WoundInfection
                                                                    Slice NameWoundInfection
                                                                    Definition

                                                                    Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                    ShortComponent results
                                                                    Comments

                                                                    For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                    Control0..1
                                                                    TypeBackboneElement
                                                                    Summarytrue
                                                                    Requirements

                                                                    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.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                    366. Observation.component:WoundInfection.id
                                                                    Definition

                                                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    Shortxml:id (or equivalent in JSON)
                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    368. Observation.component:WoundInfection.extension
                                                                    Definition

                                                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                    ShortAdditional Content defined by implementations
                                                                    Comments

                                                                    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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Alternate Namesextensions, user content
                                                                    370. Observation.component:WoundInfection.modifierExtension
                                                                    Definition

                                                                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                    ShortExtensions that cannot be ignored
                                                                    Comments

                                                                    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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                    Summarytrue
                                                                    Alternate Namesextensions, user content, modifiers
                                                                    372. Observation.component:WoundInfection.code
                                                                    Definition

                                                                    Describes what was observed. Sometimes this is called the observation "code".

                                                                    ShortType of component observation (code / type)
                                                                    Control1..1
                                                                    BindingFor example codes, see LOINC Codes
                                                                    (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                    Codes identifying names of simple observations.

                                                                    TypeCodeableConcept
                                                                    Summarytrue
                                                                    Requirements

                                                                    Knowing what kind of observation is being made is essential to understanding the observation.

                                                                    Pattern Value{
                                                                      "coding" : [{
                                                                        "system" : "http://snomed.info/sct",
                                                                        "code" : "405009004"
                                                                      }]
                                                                    }
                                                                    374. Observation.component:WoundInfection.code.id
                                                                    Definition

                                                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    Shortxml:id (or equivalent in JSON)
                                                                    Control0..1
                                                                    Typestring
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    376. Observation.component:WoundInfection.code.extension
                                                                    Definition

                                                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                    ShortAdditional Content defined by implementations
                                                                    Comments

                                                                    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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Alternate Namesextensions, user content
                                                                    SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 378. Observation.component:WoundInfection.code.coding
                                                                      Definition

                                                                      A reference to a code defined by a terminology system.

                                                                      ShortCode defined by a terminology system
                                                                      Comments

                                                                      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.

                                                                      Control0..1
                                                                      TypeCoding
                                                                      Summarytrue
                                                                      Requirements

                                                                      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                                      380. Observation.component:WoundInfection.code.coding.id
                                                                      Definition

                                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                      Shortxml:id (or equivalent in JSON)
                                                                      Control0..1
                                                                      Typestring
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      382. Observation.component:WoundInfection.code.coding.extension
                                                                      Definition

                                                                      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                      ShortAdditional Content defined by implementations
                                                                      Comments

                                                                      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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Alternate Namesextensions, user content
                                                                      SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 384. Observation.component:WoundInfection.code.coding.system
                                                                        Definition

                                                                        The identification of the code system that defines the meaning of the symbol in the code.

                                                                        ShortIdentity of the terminology system
                                                                        Comments

                                                                        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                                        Control0..1
                                                                        Typeuri
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        Need to be unambiguous about the source of the definition of the symbol.

                                                                        386. Observation.component:WoundInfection.code.coding.version
                                                                        Definition

                                                                        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.

                                                                        ShortVersion of the system - if relevant
                                                                        Comments

                                                                        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.

                                                                        NoteThis is a business versionId, not a resource version id (see discussion)
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        388. Observation.component:WoundInfection.code.coding.code
                                                                        Definition

                                                                        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).

                                                                        ShortSymbol in syntax defined by the system
                                                                        Control0..1
                                                                        Typecode
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        Need to refer to a particular code in the system.

                                                                        390. Observation.component:WoundInfection.code.coding.display
                                                                        Definition

                                                                        A representation of the meaning of the code in the system, following the rules of the system.

                                                                        ShortRepresentation defined by the system
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                        392. Observation.component:WoundInfection.code.coding.userSelected
                                                                        Definition

                                                                        Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                                        ShortIf this coding was chosen directly by the user
                                                                        Comments

                                                                        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.

                                                                        Control0..1
                                                                        Typeboolean
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        394. Observation.component:WoundInfection.code.text
                                                                        Definition

                                                                        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.

                                                                        ShortPlain text representation of the concept
                                                                        Comments

                                                                        Very often the text is the same as a displayName of one of the codings.

                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        396. Observation.component:WoundInfection.value[x]:valueCodeableConcept
                                                                        Slice NamevalueCodeableConcept
                                                                        Definition

                                                                        The information determined as a result of making the observation, if the information has a simple value.

                                                                        ShortWoundInfection
                                                                        Comments

                                                                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                                        Control0..1
                                                                        BindingThe codes SHALL be taken from v2 Yes/no Indicator
                                                                        (required to http://hl7.org/fhir/ValueSet/v2-0136)

                                                                        v2 Yes/no Indicator

                                                                        TypeCodeableConcept
                                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                        Summarytrue
                                                                        Requirements

                                                                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                                        Alternate NamesWondInfectie
                                                                        398. Observation.component:WoundInfection.dataAbsentReason
                                                                        Definition

                                                                        Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                                        ShortWhy the component result is missing
                                                                        Comments

                                                                        "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.

                                                                        Control0..1
                                                                        This element is affected by the following invariants: obs-6
                                                                        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                                        Codes specifying why the result (Observation.value[x]) is missing.

                                                                        TypeCodeableConcept
                                                                        Requirements

                                                                        For many results it is necessary to handle exceptional values in measurements.

                                                                        400. Observation.component:WoundInfection.interpretation
                                                                        Definition

                                                                        The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                                        ShortHigh, low, normal, etc.
                                                                        Comments

                                                                        The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                                        Control0..1
                                                                        BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                        Codes identifying interpretations of observations.

                                                                        TypeCodeableConcept
                                                                        Requirements

                                                                        For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                        Alternate NamesAbnormal Flag
                                                                        402. Observation.component:WoundInfection.referenceRange
                                                                        Definition

                                                                        Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                        ShortProvides guide for interpretation of component result
                                                                        Comments

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

                                                                        Control0..*
                                                                        TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                        Requirements

                                                                        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.

                                                                        404. Observation.component:WoundMoisture
                                                                        Slice NameWoundMoisture
                                                                        Definition

                                                                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                        ShortComponent results
                                                                        Comments

                                                                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                        Control0..1
                                                                        TypeBackboneElement
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                        406. Observation.component:WoundMoisture.id
                                                                        Definition

                                                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        Shortxml:id (or equivalent in JSON)
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        408. Observation.component:WoundMoisture.extension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                        ShortAdditional Content defined by implementations
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Alternate Namesextensions, user content
                                                                        410. Observation.component:WoundMoisture.modifierExtension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                        ShortExtensions that cannot be ignored
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                        Summarytrue
                                                                        Alternate Namesextensions, user content, modifiers
                                                                        412. Observation.component:WoundMoisture.code
                                                                        Definition

                                                                        Describes what was observed. Sometimes this is called the observation "code".

                                                                        ShortType of component observation (code / type)
                                                                        Control1..1
                                                                        BindingFor example codes, see LOINC Codes
                                                                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                        Codes identifying names of simple observations.

                                                                        TypeCodeableConcept
                                                                        Summarytrue
                                                                        Requirements

                                                                        Knowing what kind of observation is being made is essential to understanding the observation.

                                                                        Pattern Value{
                                                                          "coding" : [{
                                                                            "system" : "http://snomed.info/sct",
                                                                            "code" : "298007001"
                                                                          }]
                                                                        }
                                                                        414. Observation.component:WoundMoisture.value[x]:valueCodeableConcept
                                                                        Slice NamevalueCodeableConcept
                                                                        Definition

                                                                        Description of the moisture in the wound.

                                                                        ShortWoundMoisture
                                                                        Comments

                                                                        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                                        Control0..1
                                                                        BindingUnless not suitable, these codes SHALL be taken from WondVochtigheidCodelijst
                                                                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.3--20171231000000)

                                                                        WondVochtigheidCodelijst

                                                                        TypeCodeableConcept
                                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                        Summarytrue
                                                                        Requirements

                                                                        An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                                        Alternate NamesWondVochtigheid
                                                                        416. Observation.component:WoundMoisture.dataAbsentReason
                                                                        Definition

                                                                        Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                                        ShortWhy the component result is missing
                                                                        Comments

                                                                        "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.

                                                                        Control0..1
                                                                        This element is affected by the following invariants: obs-6
                                                                        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                                        Codes specifying why the result (Observation.value[x]) is missing.

                                                                        TypeCodeableConcept
                                                                        Requirements

                                                                        For many results it is necessary to handle exceptional values in measurements.

                                                                        418. Observation.component:WoundMoisture.interpretation
                                                                        Definition

                                                                        The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                                        ShortHigh, low, normal, etc.
                                                                        Comments

                                                                        The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                                        Control0..1
                                                                        BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                        Codes identifying interpretations of observations.

                                                                        TypeCodeableConcept
                                                                        Requirements

                                                                        For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                        Alternate NamesAbnormal Flag
                                                                        420. Observation.component:WoundMoisture.referenceRange
                                                                        Definition

                                                                        Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                        ShortProvides guide for interpretation of component result
                                                                        Comments

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

                                                                        Control0..*
                                                                        TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                        Requirements

                                                                        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.

                                                                        422. Observation.component:WoundEdge
                                                                        Slice NameWoundEdge
                                                                        Definition

                                                                        Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                        ShortComponent results
                                                                        Comments

                                                                        For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                        Control0..1
                                                                        TypeBackboneElement
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                        424. Observation.component:WoundEdge.id
                                                                        Definition

                                                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        Shortxml:id (or equivalent in JSON)
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        426. Observation.component:WoundEdge.extension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                        ShortAdditional Content defined by implementations
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Alternate Namesextensions, user content
                                                                        428. Observation.component:WoundEdge.modifierExtension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                        ShortExtensions that cannot be ignored
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                                        Summarytrue
                                                                        Alternate Namesextensions, user content, modifiers
                                                                        430. Observation.component:WoundEdge.code
                                                                        Definition

                                                                        Describes what was observed. Sometimes this is called the observation "code".

                                                                        ShortType of component observation (code / type)
                                                                        Control1..1
                                                                        BindingFor example codes, see LOINC Codes
                                                                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                        Codes identifying names of simple observations.

                                                                        TypeCodeableConcept
                                                                        Summarytrue
                                                                        Requirements

                                                                        Knowing what kind of observation is being made is essential to understanding the observation.

                                                                        Pattern Value{
                                                                          "coding" : [{
                                                                            "system" : "http://snomed.info/sct",
                                                                            "code" : "449747006"
                                                                          }]
                                                                        }
                                                                        432. Observation.component:WoundEdge.code.id
                                                                        Definition

                                                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        Shortxml:id (or equivalent in JSON)
                                                                        Control0..1
                                                                        Typestring
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        434. Observation.component:WoundEdge.code.extension
                                                                        Definition

                                                                        May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                        ShortAdditional Content defined by implementations
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Alternate Namesextensions, user content
                                                                        SlicingThis element introduces a set of slices on Observation.component.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 436. Observation.component:WoundEdge.code.coding
                                                                          Definition

                                                                          A reference to a code defined by a terminology system.

                                                                          ShortCode defined by a terminology system
                                                                          Comments

                                                                          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.

                                                                          Control0..*
                                                                          TypeCoding
                                                                          Summarytrue
                                                                          Requirements

                                                                          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                                          438. Observation.component:WoundEdge.code.coding.id
                                                                          Definition

                                                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          Shortxml:id (or equivalent in JSON)
                                                                          Control0..1
                                                                          Typestring
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          440. Observation.component:WoundEdge.code.coding.extension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                          ShortAdditional Content defined by implementations
                                                                          Comments

                                                                          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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Alternate Namesextensions, user content
                                                                          SlicingThis element introduces a set of slices on Observation.component.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 442. Observation.component:WoundEdge.code.coding.system
                                                                            Definition

                                                                            The identification of the code system that defines the meaning of the symbol in the code.

                                                                            ShortIdentity of the terminology system
                                                                            Comments

                                                                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                                                            Control0..1
                                                                            Typeuri
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            Need to be unambiguous about the source of the definition of the symbol.

                                                                            444. Observation.component:WoundEdge.code.coding.version
                                                                            Definition

                                                                            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.

                                                                            ShortVersion of the system - if relevant
                                                                            Comments

                                                                            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.

                                                                            NoteThis is a business versionId, not a resource version id (see discussion)
                                                                            Control0..1
                                                                            Typestring
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            446. Observation.component:WoundEdge.code.coding.code
                                                                            Definition

                                                                            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).

                                                                            ShortSymbol in syntax defined by the system
                                                                            Control0..1
                                                                            Typecode
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            Need to refer to a particular code in the system.

                                                                            448. Observation.component:WoundEdge.code.coding.display
                                                                            Definition

                                                                            A representation of the meaning of the code in the system, following the rules of the system.

                                                                            ShortRepresentation defined by the system
                                                                            Control0..1
                                                                            Typestring
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                            450. Observation.component:WoundEdge.code.coding.userSelected
                                                                            Definition

                                                                            Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                                                            ShortIf this coding was chosen directly by the user
                                                                            Comments

                                                                            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.

                                                                            Control0..1
                                                                            Typeboolean
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            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.

                                                                            452. Observation.component:WoundEdge.code.text
                                                                            Definition

                                                                            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.

                                                                            ShortPlain text representation of the concept
                                                                            Comments

                                                                            Very often the text is the same as a displayName of one of the codings.

                                                                            Control0..1
                                                                            Typestring
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            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.

                                                                            454. Observation.component:WoundEdge.value[x]:valueCodeableConcept
                                                                            Slice NamevalueCodeableConcept
                                                                            Definition

                                                                            Description of the condition of the outer edges of the wound.

                                                                            ShortWoundEdge
                                                                            Comments

                                                                            Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                                            Control0..1
                                                                            BindingUnless not suitable, these codes SHALL be taken from WondRandCodelijst
                                                                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.19.2.5--20171231000000)

                                                                            WondRandCodelijst

                                                                            TypeCodeableConcept
                                                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                            Summarytrue
                                                                            Requirements

                                                                            An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

                                                                            Alternate NamesWondRand
                                                                            456. Observation.component:WoundEdge.dataAbsentReason
                                                                            Definition

                                                                            Provides a reason why the expected value in the element Observation.value[x] is missing.

                                                                            ShortWhy the component result is missing
                                                                            Comments

                                                                            "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.

                                                                            Control0..1
                                                                            This element is affected by the following invariants: obs-6
                                                                            BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                                                            (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

                                                                            Codes specifying why the result (Observation.value[x]) is missing.

                                                                            TypeCodeableConcept
                                                                            Requirements

                                                                            For many results it is necessary to handle exceptional values in measurements.

                                                                            458. Observation.component:WoundEdge.interpretation
                                                                            Definition

                                                                            The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                                                            ShortHigh, low, normal, etc.
                                                                            Comments

                                                                            The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.

                                                                            Control0..1
                                                                            BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                                                            (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                                                            Codes identifying interpretations of observations.

                                                                            TypeCodeableConcept
                                                                            Requirements

                                                                            For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                            Alternate NamesAbnormal Flag
                                                                            460. Observation.component:WoundEdge.referenceRange
                                                                            Definition

                                                                            Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                            ShortProvides guide for interpretation of component result
                                                                            Comments

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

                                                                            Control0..*
                                                                            TypeSee ttp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                            Requirements

                                                                            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.