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: Zib BloodPressure - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-BloodPressure resource profile.

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

0. Observation
Definition

The FHIR BloodPressure profile sets a minimum expectations for the Observation Resource to record, search and fetch the blood pressure associated with a patient.

ShortBloodPressure
Alternate NamesBloeddruk
2. Observation.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
4. Observation.subject
6. Observation.effective[x]
ShortBloodPressureDateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Alternate NamesBloeddrukDatumTijd
8. Observation.performer
10. Observation.comment
Definition

Comments on the measured blood pressure. Here, an explanation could be given, for example, of circumstances that may have influenced the patient’s blood pressure, such as pain, stress, exertion and sleep/wake cycles.

ShortComment
Alternate NamesToelichting
12. Observation.bodySite
Definition

Anatomical location where the blood pressure was measured.

ShortMeasuringLocation
BindingUnless not suitable, these codes SHALL be taken from MeetLocatieCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.4--20171231000000)

MeetLocatieCodelijst

Alternate NamesMeetLocatie
14. Observation.method
Definition

The type of method used to measure blood pressure.

ShortMeasuringMethod
BindingUnless not suitable, these codes SHALL be taken from MeetmethodeCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.1--20171231000000)

MeetmethodeCodelijst

Alternate NamesMeetmethode
16. 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:
  • value @ code.coding.code
  • value @ code.coding.system
  • 18. Observation.component:SystolicBP
    Slice NameSystolicBP
    Control1..1
    20. Observation.component:SystolicBP.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

    22. Observation.component:SystolicBP.code.coding
    Control1..?
    24. Observation.component:SystolicBP.code.coding.system
    Fixed Valuehttp://loinc.org
    26. Observation.component:SystolicBP.code.coding.code
    Fixed Value8480-6
    28. Observation.component:SystolicBP.valueQuantity:valueQuantity
    Slice NamevalueQuantity
    Definition

    The highest (peak) systematic arterial blood pressure - measured in the contraction stage or systole of the cardiac cycle.

    ShortSystolicBloodPressure recorded with UCUM
    Control1..?
    TypeQuantity
    Alternate NamesSystolischeBloeddruk
    30. Observation.component:SystolicBP.valueQuantity:valueQuantity.code
    Fixed Valuemm[Hg]
    32. Observation.component:DiastolicBP
    Slice NameDiastolicBP
    Control1..1
    34. Observation.component:DiastolicBP.code
    Definition

    The lowest systematic arterial blood pressure - measured in the relaxation stage or diastole of the cardiac cycle.

    ShortDiastolicBloodPressure recorded with UCUM
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

    Alternate NamesDiastolischeBloeddruk
    36. Observation.component:DiastolicBP.code.coding
    Control1..?
    38. Observation.component:DiastolicBP.code.coding.system
    Fixed Valuehttp://loinc.org
    40. Observation.component:DiastolicBP.code.coding.code
    Fixed Value8462-4
    42. Observation.component:DiastolicBP.valueQuantity:valueQuantity
    Slice NamevalueQuantity
    TypeQuantity
    44. Observation.component:DiastolicBP.valueQuantity:valueQuantity.code
    Fixed Valuemm[Hg]
    46. Observation.component:AverageBloodPressureLOINC
    Slice NameAverageBloodPressureLOINC
    Control0..1
    48. Observation.component:AverageBloodPressureLOINC.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

    50. Observation.component:AverageBloodPressureLOINC.code.coding
    Control1..?
    52. Observation.component:AverageBloodPressureLOINC.code.coding.system
    Fixed Valuehttp://loinc.org
    54. Observation.component:AverageBloodPressureLOINC.code.coding.code
    Fixed Value8478-0
    56. Observation.component:AverageBloodPressureLOINC.valueQuantity:valueQuantity
    Slice NamevalueQuantity
    Definition

    Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.

    ShortAverageBloodPressure recorded with UCUM
    TypeQuantity
    Alternate NamesGemiddeldeBloeddruk
    58. Observation.component:AverageBloodPressureLOINC.valueQuantity:valueQuantity.code
    Fixed Valuemm[Hg]
    60. Observation.component:AverageBloodPressureSNOMED
    Slice NameAverageBloodPressureSNOMED
    Control0..1
    62. Observation.component:AverageBloodPressureSNOMED.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

    64. Observation.component:AverageBloodPressureSNOMED.code.coding
    66. Observation.component:AverageBloodPressureSNOMED.code.coding.system
    Fixed Valuehttp://snomed.info/sct
    68. Observation.component:AverageBloodPressureSNOMED.code.coding.code
    Fixed Value6797001
    70. Observation.component:AverageBloodPressureSNOMED.valueQuantity:valueQuantity
    Slice NamevalueQuantity
    Definition

    Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.

    ShortAverageBloodPressure recorded with UCUM
    TypeQuantity
    Alternate NamesGemiddeldeBloeddruk
    72. Observation.component:AverageBloodPressureSNOMED.valueQuantity:valueQuantity.code
    Fixed Valuemm[Hg]
    74. Observation.component:diastolicEndpoint
    Slice NamediastolicEndpoint
    ShortDiastolicEndpoint
    Control0..1
    76. Observation.component:diastolicEndpoint.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

    Alternate NamesComponent Test, Component Name
    78. Observation.component:diastolicEndpoint.code.coding
    Control1..?
    80. Observation.component:diastolicEndpoint.code.coding.system
    Fixed Valuehttp://snomed.info/sct
    82. Observation.component:diastolicEndpoint.code.coding.code
    Fixed Value85549003
    84. Observation.component:diastolicEndpoint.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    Registration of the Korotkoff sound used to measure diastolic pressure with the auscultatory method.

    ShortDiastolicEndpoint
    BindingUnless not suitable, these codes SHALL be taken from DiastolischEindpuntCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.2--20171231000000)

    DiastolischEindpuntCodelijst

    TypeCodeableConcept
    Alternate NamesDiastolischEindpunt
    86. Observation.component:cuffTypeLOINC
    Slice NamecuffTypeLOINC
    Control0..1
    88. Observation.component:cuffTypeLOINC.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

    Alternate NamesComponent Test, Component Name
    90. Observation.component:cuffTypeLOINC.code.coding
    Control1..?
    92. Observation.component:cuffTypeLOINC.code.coding.system
    Fixed Valuehttp://loinc.org
    94. Observation.component:cuffTypeLOINC.code.coding.code
    Fixed Value8358-4
    96. Observation.component:cuffTypeLOINC.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The size of the cuff used in the measurement.

    ShortCuffType
    BindingUnless not suitable, these codes SHALL be taken from ManchetTypeCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

    ManchetTypeCodelijst

    TypeCodeableConcept
    Alternate NamesManchetType
    98. Observation.component:cuffTypeSNOMED
    Slice NamecuffTypeSNOMED
    Control0..1
    100. Observation.component:cuffTypeSNOMED.code
    Comments

    additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

    Alternate NamesComponent Test, Component Name
    102. Observation.component:cuffTypeSNOMED.code.coding
    104. Observation.component:cuffTypeSNOMED.code.coding.system
    Fixed Valuehttp://snomed.info/sct
    106. Observation.component:cuffTypeSNOMED.code.coding.code
    Fixed Value70665002
    108. Observation.component:cuffTypeSNOMED.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The size of the cuff used in the measurement.

    ShortCuffType
    BindingUnless not suitable, these codes SHALL be taken from ManchetTypeCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

    ManchetTypeCodelijst

    TypeCodeableConcept
    Alternate NamesManchetType
    110. Observation.component:positionSNOMED
    Slice NamepositionSNOMED
    Control0..1
    112. Observation.component:positionSNOMED.code
    114. Observation.component:positionSNOMED.code.coding
    Control1..?
    116. Observation.component:positionSNOMED.code.coding.system
    Fixed Valuehttp://snomed.info/sct
    118. Observation.component:positionSNOMED.code.coding.code
    Fixed Value424724000
    120. Observation.component:positionSNOMED.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The position of the patient when the blood pressure was measured.

    ShortPosition
    BindingUnless not suitable, these codes SHALL be taken from HoudingCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

    HoudingCodelijst

    TypeCodeableConcept
    Alternate NamesHouding
    122. Observation.component:positionLOINC
    Slice NamepositionLOINC
    Control0..1
    124. Observation.component:positionLOINC.code
    126. Observation.component:positionLOINC.code.coding
    128. Observation.component:positionLOINC.code.coding.system
    Fixed Valuehttp://loinc.org
    130. Observation.component:positionLOINC.code.coding.code
    Fixed Value8361-8
    132. Observation.component:positionLOINC.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The position of the patient when the blood pressure was measured.

    ShortPosition
    BindingUnless not suitable, these codes SHALL be taken from HoudingCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

    HoudingCodelijst

    TypeCodeableConcept
    Alternate NamesHouding

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

    0. Observation
    Definition

    The FHIR BloodPressure profile sets a minimum expectations for the Observation Resource to record, search and fetch the blood pressure associated with a patient.


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

    ShortBloodPressureMeasurements 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, FHIR Vital Signs profiel, Bloeddruk
    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())
    vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present ((component.empty() and related.empty()) implies (dataAbsentReason or value))
    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.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
    6. 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.

    8. 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
    Must Supporttrue
    Summarytrue
    Requirements

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

    10. 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.

    Control10..*
    This element is affected by the following invariants: vs-4
    BindingThe codes SHOULD be taken from Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category
    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

    Codes for high level observation categories.

    TypeCodeableConcept
    Must Supporttrue
    Requirements

    Used for filtering what observations are retrieved and displayed.

    Invariantsvs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' (where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists())
    12. Observation.code
    Definition

    Coded Responses from C-CDA Vital Sign Results.


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

    ShortCoded Responses from Vital Signs ResultsType of observation (code / type)
    Control1..1
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
    (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

    This identifies the vital sign result type.


    Codes identifying names of simple observations.

    TypeCodeableConcept
    Must Supporttrue
    Summarytrue
    Requirements
    1. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).

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

    Alternate NamesName, Gecodeerde antwoorden uit Vital Signs resultaten
    14. 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(nl-core-patient, Patient, Group, Device, Location)
    Must Supporttrue
    Summarytrue
    Requirements

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

    16. Observation.effective[x]
    Definition

    Often just a dateTime for Vital Signs.


    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.

    ShortBloodPressureDateTimeClinically relevant time/time-period for observation
    Comments

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

    Control10..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
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Requirements

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

    Alternate NamesOccurrence, Meestal slechts een datum/tijd voor Vital Signs, BloeddrukDatumTijd
    18. Observation.performer
    Definition

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

    ShortWho is responsible for the observation
    Control10..*
    TypeReference(nl-core-practitioner, nl-core-organization, nl-core-relatedperson, nl-core-patient, Practitioner, Organization, Patient, RelatedPerson)
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Requirements

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

    20. Observation.performer.extension:practitionerRole
    Slice NamepractitionerRole
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
    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())
    22. 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
    TypeQuantity, dateTime, boolean, 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.

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

      Vital Sign Value recorded with UCUM.


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

      ShortVital Sign Value recorded with UCUMActual 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, vs-2
      BindingThe codes SHALL be taken from For codes, see Vital Signs Units
      (required to http://hl7.org/fhir/ValueSet/ucum-vitals-common)

      Common UCUM units for recording Vital Signs

      TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Must Supporttrue
      Summarytrue
      Requirements
      1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

      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 NamesVital Sign waarde, vastgelegd op basis van UCUM-eenheid
      26. Observation.value[x]:valueQuantity.value
      Definition

      The value of the measured amount. The value includes an implicit precision in the presentation of the value.

      ShortNumerical value (with implicit precision)
      Comments

      The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

      Precision is handled implicitly in almost all cases of measurement.

      28. Observation.value[x]:valueQuantity.comparator
      Definition

      How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

      Short< | <= | >= | > - how to understand the value
      Comments

      This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

      Control0..1
      BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
      (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

      How the Quantity should be understood and represented.

      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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

      Meaning if MissingIf there is no comparator, then there is no modification of the value
      30. Observation.value[x]:valueQuantity.unit
      Definition

      A human-readable form of the unit.

      ShortUnit representation
      Control10..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

      32. Observation.value[x]:valueQuantity.system
      Definition

      The identification of the system that provides the coded form of the unit.

      ShortSystem that defines coded unit form
      Control10..1
      This element is affected by the following invariants: qty-3
      Typeuri
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Need to know the system that defines the coded form of the unit.

      Fixed Valuehttp://unitsofmeasure.org
      34. Observation.value[x]:valueQuantity.code
      Definition

      Coded responses from the common UCUM units for vital signs value set.


      A computer processable form of the unit in some unit representation system.

      ShortCoded responses from the common UCUM units for vital signs value set.Coded form of the unit
      Comments

      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

      Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

      Alternate NamesGecodeerde antwoorden van de algemene UCUM-eenheden voor vital signs waardelijst.
      36. 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, vs-2
      BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
      (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

      TypeCodeableConcept
      Must Supporttrue
      Requirements

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

      38. Observation.comment
      Definition

      Comments on the measured blood pressure. Here, an explanation could be given, for example, of circumstances that may have influenced the patient’s blood pressure, such as pain, stress, exertion and sleep/wake cycles.


      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.

      ShortCommentComments 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.

      Alternate NamesToelichting
      40. Observation.bodySite
      Definition

      Anatomical location where the blood pressure was measured.


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

      ShortMeasuringLocationObserved 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
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see MeetLocatieCodelijsthttp://hl7.org/fhir/ValueSet/body-site
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.4--20171231000000)

      MeetLocatieCodelijst


      Codes describing anatomical locations. May include laterality.

      TypeCodeableConcept
      Alternate NamesMeetLocatie
      42. Observation.method
      Definition

      The type of method used to measure blood pressure.


      Indicates the mechanism used to perform the observation.

      ShortMeasuringMethodHow it was done
      Comments

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

      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see MeetmethodeCodelijsthttp://hl7.org/fhir/ValueSet/observation-methods
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.1--20171231000000)

      MeetmethodeCodelijst


      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.

      Alternate NamesMeetmethode
      44. Observation.related
      Definition

      Used when reporting vital signs panel components.


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

      ShortUsed when reporting vital signs panel componentsResource related to this observation
      Comments

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

      Control0..*
      TypeBackboneElement
      Must Supporttrue
      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.

      Alternate NamesGebruikt bij het rapporteren van vital signs panelcomponenten.
      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()))
      46. 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
      48. 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.

      Control10..1
      BindingThe codes SHALL be taken from ObservationRelationshipTypehttp://hl7.org/fhir/ValueSet/observation-relationshiptypes
      (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
      Must Supporttrue
      Requirements

      A relationship type SHOULD be provided.

      Fixed Valuehas-member
      50. 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(VitalSigns Profile NL, Observation, QuestionnaireResponse, Sequence)
      Must Supporttrue
      52. 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
      Must Supporttrue
      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()))
      vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
      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:
      • value @ code.coding.code
      • value @ code.coding.system
      • 54. 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
        56. Observation.component.code
        Definition

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

        ShortType of component observation (code / type)
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        58. Observation.component.value[x]
        Definition

        Vital Sign Value recorded with UCUM.


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

        ShortVital Sign Value recorded with UCUMActual 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
        This element is affected by the following invariants: vs-3
        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
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid
        60. 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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        62. Observation.component:SystolicBP
        Slice NameSystolicBP
        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.

        Control10..1*
        TypeBackboneElement
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        64. Observation.component:SystolicBP.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:SystolicBP.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        68. Observation.component:SystolicBP.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.

        70. Observation.component:SystolicBP.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.

        Fixed Valuehttp://loinc.org
        72. Observation.component:SystolicBP.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.

        Fixed Value8480-6
        74. Observation.component:SystolicBP.value[x]:valueQuantity
        Slice NamevalueQuantity
        Definition

        The highest (peak) systematic arterial blood pressure - measured in the contraction stage or systole of the cardiac cycle.


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

        ShortSystolicBloodPressure recorded with UCUMActual 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
        This element is affected by the following invariants: vs-3
        TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, SystolischeBloeddruk
        76. Observation.component:SystolicBP.value[x]:valueQuantity.comparator
        Definition

        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

        Short< | <= | >= | > - how to understand the value
        Comments

        This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

        Control0..1
        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
        (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

        How the Quantity should be understood and represented.

        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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

        Meaning if MissingIf there is no comparator, then there is no modification of the value
        78. Observation.component:SystolicBP.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        80. Observation.component:DiastolicBP
        Slice NameDiastolicBP
        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.

        Control10..1*
        TypeBackboneElement
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        82. Observation.component:DiastolicBP.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
        84. Observation.component:DiastolicBP.code
        Definition

        The lowest systematic arterial blood pressure - measured in the relaxation stage or diastole of the cardiac cycle.


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

        ShortDiastolicBloodPressure recorded with UCUMType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        Alternate NamesDiastolischeBloeddruk
        86. Observation.component:DiastolicBP.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.

        88. Observation.component:DiastolicBP.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.

        Fixed Valuehttp://loinc.org
        90. Observation.component:DiastolicBP.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.

        Fixed Value8462-4
        92. Observation.component:DiastolicBP.value[x]:valueQuantity
        Slice NamevalueQuantity
        Definition

        Vital Sign Value recorded with UCUM.


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

        ShortVital Sign Value recorded with UCUMActual 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
        This element is affected by the following invariants: vs-3
        TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid
        94. Observation.component:DiastolicBP.value[x]:valueQuantity.comparator
        Definition

        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

        Short< | <= | >= | > - how to understand the value
        Comments

        This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

        Control0..1
        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
        (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

        How the Quantity should be understood and represented.

        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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

        Meaning if MissingIf there is no comparator, then there is no modification of the value
        96. Observation.component:DiastolicBP.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        98. Observation.component:AverageBloodPressureLOINC
        Slice NameAverageBloodPressureLOINC
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        100. Observation.component:AverageBloodPressureLOINC.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
        102. Observation.component:AverageBloodPressureLOINC.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        104. Observation.component:AverageBloodPressureLOINC.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.

        106. Observation.component:AverageBloodPressureLOINC.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.

        Fixed Valuehttp://loinc.org
        108. Observation.component:AverageBloodPressureLOINC.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.

        Fixed Value8478-0
        110. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity
        Slice NamevalueQuantity
        Definition

        Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.


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

        ShortAverageBloodPressure recorded with UCUMActual 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
        This element is affected by the following invariants: vs-3
        TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, GemiddeldeBloeddruk
        112. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.comparator
        Definition

        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

        Short< | <= | >= | > - how to understand the value
        Comments

        This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

        Control0..1
        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
        (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

        How the Quantity should be understood and represented.

        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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

        Meaning if MissingIf there is no comparator, then there is no modification of the value
        114. Observation.component:AverageBloodPressureLOINC.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        116. Observation.component:AverageBloodPressureSNOMED
        Slice NameAverageBloodPressureSNOMED
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        118. Observation.component:AverageBloodPressureSNOMED.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.component:AverageBloodPressureSNOMED.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        122. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity
        Slice NamevalueQuantity
        Definition

        Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.


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

        ShortAverageBloodPressure recorded with UCUMActual 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
        This element is affected by the following invariants: vs-3
        TypeQuantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, GemiddeldeBloeddruk
        124. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.comparator
        Definition

        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

        Short< | <= | >= | > - how to understand the value
        Comments

        This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

        Control0..1
        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
        (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

        How the Quantity should be understood and represented.

        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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

        Meaning if MissingIf there is no comparator, then there is no modification of the value
        126. Observation.component:AverageBloodPressureSNOMED.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        128. Observation.component:diastolicEndpoint
        Slice NamediastolicEndpoint
        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.

        ShortDiastolicEndpointComponent results
        Comments

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

        Control0..1*
        TypeBackboneElement
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        130. Observation.component:diastolicEndpoint.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
        132. Observation.component:diastolicEndpoint.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        Alternate NamesComponent Test, Component Name
        134. Observation.component:diastolicEndpoint.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.

        136. Observation.component:diastolicEndpoint.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.

        Fixed Valuehttp://snomed.info/sct
        138. Observation.component:diastolicEndpoint.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.

        Fixed Value85549003
        140. Observation.component:diastolicEndpoint.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        Registration of the Korotkoff sound used to measure diastolic pressure with the auscultatory method.


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

        ShortDiastolicEndpointActual 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
        This element is affected by the following invariants: vs-3
        BindingUnless not suitable, these codes SHALL be taken from For codes, see DiastolischEindpuntCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.2--20171231000000)

        DiastolischEindpuntCodelijst

        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, DiastolischEindpunt
        142. Observation.component:diastolicEndpoint.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        144. Observation.component:cuffTypeLOINC
        Slice NamecuffTypeLOINC
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        146. Observation.component:cuffTypeLOINC.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
        148. Observation.component:cuffTypeLOINC.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        Alternate NamesComponent Test, Component Name
        150. Observation.component:cuffTypeLOINC.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.

        152. Observation.component:cuffTypeLOINC.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.

        Fixed Valuehttp://loinc.org
        154. Observation.component:cuffTypeLOINC.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.

        Fixed Value8358-4
        156. Observation.component:cuffTypeLOINC.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The size of the cuff used in the measurement.


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

        ShortCuffTypeActual 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
        This element is affected by the following invariants: vs-3
        BindingUnless not suitable, these codes SHALL be taken from For codes, see ManchetTypeCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

        ManchetTypeCodelijst

        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, ManchetType
        158. Observation.component:cuffTypeLOINC.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        160. Observation.component:cuffTypeSNOMED
        Slice NamecuffTypeSNOMED
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        162. Observation.component:cuffTypeSNOMED.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
        164. Observation.component:cuffTypeSNOMED.code
        Definition

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

        ShortType of component observation (code / type)
        Comments

        additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        Alternate NamesComponent Test, Component Name
        166. Observation.component:cuffTypeSNOMED.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The size of the cuff used in the measurement.


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

        ShortCuffTypeActual 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
        This element is affected by the following invariants: vs-3
        BindingUnless not suitable, these codes SHALL be taken from For codes, see ManchetTypeCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

        ManchetTypeCodelijst

        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, ManchetType
        168. Observation.component:cuffTypeSNOMED.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        170. Observation.component:positionSNOMED
        Slice NamepositionSNOMED
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        172. Observation.component:positionSNOMED.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
        174. Observation.component:positionSNOMED.code
        Definition

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

        ShortType of component observation (code / type)
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        176. Observation.component:positionSNOMED.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.

        178. Observation.component:positionSNOMED.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.

        Fixed Valuehttp://snomed.info/sct
        180. Observation.component:positionSNOMED.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.

        Fixed Value424724000
        182. Observation.component:positionSNOMED.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The position of the patient when the blood pressure was measured.


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

        ShortPositionActual 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
        This element is affected by the following invariants: vs-3
        BindingUnless not suitable, these codes SHALL be taken from For codes, see HoudingCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

        HoudingCodelijst

        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, Houding
        184. Observation.component:positionSNOMED.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

        186. Observation.component:positionLOINC
        Slice NamepositionLOINC
        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
        Must Supporttrue
        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()))
        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        188. Observation.component:positionLOINC.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
        190. Observation.component:positionLOINC.code
        Definition

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

        ShortType of component observation (code / type)
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Vital Signshttp://hl7.org/fhir/ValueSet/observation-codes
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.


        Codes identifying names of simple observations.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements

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

        192. Observation.component:positionLOINC.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The position of the patient when the blood pressure was measured.


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

        ShortPositionActual 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
        This element is affected by the following invariants: vs-3
        BindingUnless not suitable, these codes SHALL be taken from For codes, see HoudingCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

        HoudingCodelijst

        TypeCodeableConcept, dateTime, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

        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 NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, Houding
        194. Observation.component:positionLOINC.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, vs-3
        BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reasonhttp://hl7.org/fhir/ValueSet/observation-valueabsentreason
        (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

        TypeCodeableConcept
        Must Supporttrue
        Requirements

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

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

        0. Observation
        Definition

        The FHIR BloodPressure profile sets a minimum expectations for the Observation Resource to record, search and fetch the blood pressure associated with a patient.

        ShortBloodPressure
        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, FHIR Vital Signs profiel, Bloeddruk
        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())
        vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present ((component.empty() and related.empty()) implies (dataAbsentReason or value))
        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

        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.

        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
        16. 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
        18. 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.

        20. 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
        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 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
        Must Supporttrue
        Summarytrue
        Requirements

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

        24. 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.

        Control1..*
        This element is affected by the following invariants: vs-4
        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
        Must Supporttrue
        Requirements

        Used for filtering what observations are retrieved and displayed.

        Invariantsvs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' (where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists())
        26. Observation.code
        Definition

        Coded Responses from C-CDA Vital Sign Results.

        ShortCoded Responses from Vital Signs Results
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from Vital Signs
        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

        This identifies the vital sign result type.

        TypeCodeableConcept
        Must Supporttrue
        Summarytrue
        Requirements
        1. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
        Alternate NamesName, Gecodeerde antwoorden uit Vital Signs resultaten
        28. 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(nl-core-patient)
        Must Supporttrue
        Summarytrue
        Requirements

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

        30. 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
        32. Observation.effective[x]
        Definition

        Often just a dateTime for Vital Signs.

        ShortBloodPressureDateTime
        Comments

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

        Control1..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
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements

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

        Alternate NamesOccurrence, Meestal slechts een datum/tijd voor Vital Signs, BloeddrukDatumTijd
        34. 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
        36. Observation.performer
        Definition

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

        ShortWho is responsible for the observation
        Control1..*
        TypeReference(nl-core-practitioner, nl-core-organization, nl-core-relatedperson, nl-core-patient)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements

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

        38. 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.
        40. 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
        • 42. Observation.performer.extension:practitionerRole
          Slice NamepractitionerRole
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
          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())
          44. 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
          46. 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
          48. 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
          50. 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
          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.

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

            Vital Sign Value recorded with UCUM.

            ShortVital Sign Value recorded with UCUM
            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, vs-2
            BindingThe codes SHALL be taken from Vital Signs Units
            (required to http://hl7.org/fhir/ValueSet/ucum-vitals-common)

            Common UCUM units for recording Vital Signs

            TypeQuantity
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Must Supporttrue
            Summarytrue
            Requirements
            1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
            Alternate NamesVital Sign waarde, vastgelegd op basis van UCUM-eenheid
            54. Observation.value[x]:valueQuantity.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.
            56. Observation.value[x]:valueQuantity.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.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 58. Observation.value[x]:valueQuantity.value
              Definition

              The value of the measured amount. The value includes an implicit precision in the presentation of the value.

              ShortNumerical value (with implicit precision)
              Comments

              The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

              Precision is handled implicitly in almost all cases of measurement.

              60. Observation.value[x]:valueQuantity.comparator
              Definition

              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

              Short< | <= | >= | > - how to understand the value
              Comments

              This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

              Control0..1
              BindingThe codes SHALL be taken from QuantityComparator
              (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

              How the Quantity should be understood and represented.

              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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

              Meaning if MissingIf there is no comparator, then there is no modification of the value
              62. Observation.value[x]:valueQuantity.unit
              Definition

              A human-readable form of the unit.

              ShortUnit representation
              Control1..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

              64. Observation.value[x]:valueQuantity.system
              Definition

              The identification of the system that provides the coded form of the unit.

              ShortSystem that defines coded unit form
              Control1..1
              This element is affected by the following invariants: qty-3
              Typeuri
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Need to know the system that defines the coded form of the unit.

              Fixed Valuehttp://unitsofmeasure.org
              66. Observation.value[x]:valueQuantity.code
              Definition

              Coded responses from the common UCUM units for vital signs value set.

              ShortCoded responses from the common UCUM units for vital signs value set.
              Comments

              The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

              Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

              Alternate NamesGecodeerde antwoorden van de algemene UCUM-eenheden voor vital signs waardelijst.
              68. 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, vs-2
              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
              Must Supporttrue
              Requirements

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

              70. 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
              72. Observation.comment
              Definition

              Comments on the measured blood pressure. Here, an explanation could be given, for example, of circumstances that may have influenced the patient’s blood pressure, such as pain, stress, exertion and sleep/wake cycles.

              ShortComment
              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.

              Alternate NamesToelichting
              74. Observation.bodySite
              Definition

              Anatomical location where the blood pressure was measured.

              ShortMeasuringLocation
              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
              BindingUnless not suitable, these codes SHALL be taken from MeetLocatieCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.4--20171231000000)

              MeetLocatieCodelijst

              TypeCodeableConcept
              Alternate NamesMeetLocatie
              76. Observation.method
              Definition

              The type of method used to measure blood pressure.

              ShortMeasuringMethod
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from MeetmethodeCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.1--20171231000000)

              MeetmethodeCodelijst

              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.

              Alternate NamesMeetmethode
              78. 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)
              80. 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(HCIM MedicalDevice Product)
              82. 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())
              84. 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.
              86. 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
              88. 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
              90. 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)
              92. 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)
              94. 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.

              96. 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.

              98. 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.

              100. 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
              102. Observation.related
              Definition

              Used when reporting vital signs panel components.

              ShortUsed when reporting vital signs panel components
              Comments

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

              Control0..*
              TypeBackboneElement
              Must Supporttrue
              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.

              Alternate NamesGebruikt bij het rapporteren van vital signs panelcomponenten.
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              104. 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.
              106. 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
              108. 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
              110. 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.

              Control1..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
              Must Supporttrue
              Requirements

              A relationship type SHOULD be provided.

              Fixed Valuehas-member
              112. 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(VitalSigns Profile NL)
              Must Supporttrue
              114. 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
              Must Supporttrue
              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()))
              vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
              SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ code.coding.code
              • value @ code.coding.system
              • 116. 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.
                118. 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
                120. 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
                122. Observation.component.code
                Definition

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

                ShortType of component observation (code / type)
                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                This identifies the vital sign result type.

                TypeCodeableConcept
                Must Supporttrue
                Summarytrue
                Requirements

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

                124. Observation.component.value[x]
                Definition

                Vital Sign Value recorded with UCUM.

                ShortVital Sign Value recorded with UCUM
                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
                This element is affected by the following invariants: vs-3
                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
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Requirements
                1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid
                126. 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, vs-3
                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
                Must Supporttrue
                Requirements

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

                128. 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
                130. 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.

                132. Observation.component:SystolicBP
                Slice NameSystolicBP
                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.

                Control1..1
                TypeBackboneElement
                Must Supporttrue
                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()))
                vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                134. Observation.component:SystolicBP.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.component:SystolicBP.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.component:SystolicBP.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.component:SystolicBP.code
                Definition

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

                ShortType of component observation (code / type)
                Comments

                additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                This identifies the vital sign result type.

                TypeCodeableConcept
                Must Supporttrue
                Summarytrue
                Requirements

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

                142. Observation.component:SystolicBP.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.
                144. Observation.component:SystolicBP.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
                • 146. Observation.component:SystolicBP.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.

                  148. Observation.component:SystolicBP.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.
                  150. Observation.component:SystolicBP.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
                  • 152. Observation.component:SystolicBP.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.

                    Fixed Valuehttp://loinc.org
                    154. Observation.component:SystolicBP.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
                    156. Observation.component:SystolicBP.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.

                    Fixed Value8480-6
                    158. Observation.component:SystolicBP.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.

                    160. Observation.component:SystolicBP.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.

                    162. Observation.component:SystolicBP.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.

                    164. Observation.component:SystolicBP.value[x]:valueQuantity
                    Slice NamevalueQuantity
                    Definition

                    The highest (peak) systematic arterial blood pressure - measured in the contraction stage or systole of the cardiac cycle.

                    ShortSystolicBloodPressure recorded with UCUM
                    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
                    This element is affected by the following invariants: vs-3
                    TypeQuantity
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Must Supporttrue
                    Summarytrue
                    Requirements
                    1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                    Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, SystolischeBloeddruk
                    166. Observation.component:SystolicBP.value[x]:valueQuantity.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.
                    168. Observation.component:SystolicBP.value[x]:valueQuantity.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
                    • 170. Observation.component:SystolicBP.value[x]:valueQuantity.value
                      Definition

                      The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                      ShortNumerical value (with implicit precision)
                      Comments

                      The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

                      Precision is handled implicitly in almost all cases of measurement.

                      172. Observation.component:SystolicBP.value[x]:valueQuantity.comparator
                      Definition

                      How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                      Short< | <= | >= | > - how to understand the value
                      Comments

                      This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

                      Control0..1
                      BindingThe codes SHALL be taken from QuantityComparator
                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                      How the Quantity should be understood and represented.

                      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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                      174. Observation.component:SystolicBP.value[x]:valueQuantity.unit
                      Definition

                      A human-readable form of the unit.

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

                      There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                      176. Observation.component:SystolicBP.value[x]:valueQuantity.system
                      Definition

                      The identification of the system that provides the coded form of the unit.

                      ShortSystem that defines coded unit form
                      Control0..1
                      This element is affected by the following invariants: qty-3
                      Typeuri
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      Need to know the system that defines the coded form of the unit.

                      178. Observation.component:SystolicBP.value[x]:valueQuantity.code
                      Definition

                      A computer processable form of the unit in some unit representation system.

                      ShortCoded form of the unit
                      Comments

                      The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

                      Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                      Fixed Valuemm[Hg]
                      180. Observation.component:SystolicBP.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, vs-3
                      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
                      Must Supporttrue
                      Requirements

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

                      182. Observation.component:SystolicBP.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
                      184. Observation.component:SystolicBP.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.

                      186. Observation.component:DiastolicBP
                      Slice NameDiastolicBP
                      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.

                      Control1..1
                      TypeBackboneElement
                      Must Supporttrue
                      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()))
                      vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                      188. Observation.component:DiastolicBP.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.
                      190. Observation.component:DiastolicBP.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
                      192. Observation.component:DiastolicBP.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
                      194. Observation.component:DiastolicBP.code
                      Definition

                      The lowest systematic arterial blood pressure - measured in the relaxation stage or diastole of the cardiac cycle.

                      ShortDiastolicBloodPressure recorded with UCUM
                      Comments

                      additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                      (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                      This identifies the vital sign result type.

                      TypeCodeableConcept
                      Must Supporttrue
                      Summarytrue
                      Requirements

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

                      Alternate NamesDiastolischeBloeddruk
                      196. Observation.component:DiastolicBP.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.
                      198. Observation.component:DiastolicBP.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
                      • 200. Observation.component:DiastolicBP.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.

                        202. Observation.component:DiastolicBP.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.
                        204. Observation.component:DiastolicBP.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
                        • 206. Observation.component:DiastolicBP.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.

                          Fixed Valuehttp://loinc.org
                          208. Observation.component:DiastolicBP.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
                          210. Observation.component:DiastolicBP.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.

                          Fixed Value8462-4
                          212. Observation.component:DiastolicBP.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.

                          214. Observation.component:DiastolicBP.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.

                          216. Observation.component:DiastolicBP.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.

                          218. Observation.component:DiastolicBP.value[x]:valueQuantity
                          Slice NamevalueQuantity
                          Definition

                          Vital Sign Value recorded with UCUM.

                          ShortVital Sign Value recorded with UCUM
                          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
                          This element is affected by the following invariants: vs-3
                          TypeQuantity
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Must Supporttrue
                          Summarytrue
                          Requirements
                          1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                          Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid
                          220. Observation.component:DiastolicBP.value[x]:valueQuantity.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.
                          222. Observation.component:DiastolicBP.value[x]:valueQuantity.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
                          • 224. Observation.component:DiastolicBP.value[x]:valueQuantity.value
                            Definition

                            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                            ShortNumerical value (with implicit precision)
                            Comments

                            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

                            Precision is handled implicitly in almost all cases of measurement.

                            226. Observation.component:DiastolicBP.value[x]:valueQuantity.comparator
                            Definition

                            How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                            Short< | <= | >= | > - how to understand the value
                            Comments

                            This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

                            Control0..1
                            BindingThe codes SHALL be taken from QuantityComparator
                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                            How the Quantity should be understood and represented.

                            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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                            228. Observation.component:DiastolicBP.value[x]:valueQuantity.unit
                            Definition

                            A human-readable form of the unit.

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

                            There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                            230. Observation.component:DiastolicBP.value[x]:valueQuantity.system
                            Definition

                            The identification of the system that provides the coded form of the unit.

                            ShortSystem that defines coded unit form
                            Control0..1
                            This element is affected by the following invariants: qty-3
                            Typeuri
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to know the system that defines the coded form of the unit.

                            232. Observation.component:DiastolicBP.value[x]:valueQuantity.code
                            Definition

                            A computer processable form of the unit in some unit representation system.

                            ShortCoded form of the unit
                            Comments

                            The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

                            Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                            Fixed Valuemm[Hg]
                            234. Observation.component:DiastolicBP.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, vs-3
                            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
                            Must Supporttrue
                            Requirements

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

                            236. Observation.component:DiastolicBP.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
                            238. Observation.component:DiastolicBP.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.

                            240. Observation.component:AverageBloodPressureLOINC
                            Slice NameAverageBloodPressureLOINC
                            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
                            Must Supporttrue
                            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()))
                            vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                            242. Observation.component:AverageBloodPressureLOINC.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.
                            244. Observation.component:AverageBloodPressureLOINC.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
                            246. Observation.component:AverageBloodPressureLOINC.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
                            248. Observation.component:AverageBloodPressureLOINC.code
                            Definition

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

                            ShortType of component observation (code / type)
                            Comments

                            additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                            (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                            This identifies the vital sign result type.

                            TypeCodeableConcept
                            Must Supporttrue
                            Summarytrue
                            Requirements

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

                            250. Observation.component:AverageBloodPressureLOINC.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.
                            252. Observation.component:AverageBloodPressureLOINC.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
                            • 254. Observation.component:AverageBloodPressureLOINC.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.

                              256. Observation.component:AverageBloodPressureLOINC.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.
                              258. Observation.component:AverageBloodPressureLOINC.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
                              • 260. Observation.component:AverageBloodPressureLOINC.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.

                                Fixed Valuehttp://loinc.org
                                262. Observation.component:AverageBloodPressureLOINC.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
                                264. Observation.component:AverageBloodPressureLOINC.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.

                                Fixed Value8478-0
                                266. Observation.component:AverageBloodPressureLOINC.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.

                                268. Observation.component:AverageBloodPressureLOINC.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.

                                270. Observation.component:AverageBloodPressureLOINC.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.

                                272. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity
                                Slice NamevalueQuantity
                                Definition

                                Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.

                                ShortAverageBloodPressure recorded with UCUM
                                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
                                This element is affected by the following invariants: vs-3
                                TypeQuantity
                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                Must Supporttrue
                                Summarytrue
                                Requirements
                                1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, GemiddeldeBloeddruk
                                274. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.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.
                                276. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.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
                                • 278. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.value
                                  Definition

                                  The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                  ShortNumerical value (with implicit precision)
                                  Comments

                                  The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

                                  Precision is handled implicitly in almost all cases of measurement.

                                  280. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.comparator
                                  Definition

                                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                  Short< | <= | >= | > - how to understand the value
                                  Comments

                                  This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

                                  Control0..1
                                  BindingThe codes SHALL be taken from QuantityComparator
                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                                  How the Quantity should be understood and represented.

                                  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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                  282. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.unit
                                  Definition

                                  A human-readable form of the unit.

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

                                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                  284. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.system
                                  Definition

                                  The identification of the system that provides the coded form of the unit.

                                  ShortSystem that defines coded unit form
                                  Control0..1
                                  This element is affected by the following invariants: qty-3
                                  Typeuri
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to know the system that defines the coded form of the unit.

                                  286. Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.code
                                  Definition

                                  A computer processable form of the unit in some unit representation system.

                                  ShortCoded form of the unit
                                  Comments

                                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

                                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                  Fixed Valuemm[Hg]
                                  288. Observation.component:AverageBloodPressureLOINC.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, vs-3
                                  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
                                  Must Supporttrue
                                  Requirements

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

                                  290. Observation.component:AverageBloodPressureLOINC.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
                                  292. Observation.component:AverageBloodPressureLOINC.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.

                                  294. Observation.component:AverageBloodPressureSNOMED
                                  Slice NameAverageBloodPressureSNOMED
                                  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
                                  Must Supporttrue
                                  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()))
                                  vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                  296. Observation.component:AverageBloodPressureSNOMED.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.
                                  298. Observation.component:AverageBloodPressureSNOMED.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
                                  300. Observation.component:AverageBloodPressureSNOMED.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
                                  302. Observation.component:AverageBloodPressureSNOMED.code
                                  Definition

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

                                  ShortType of component observation (code / type)
                                  Comments

                                  additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                  (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                  This identifies the vital sign result type.

                                  TypeCodeableConcept
                                  Must Supporttrue
                                  Summarytrue
                                  Requirements

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

                                  304. Observation.component:AverageBloodPressureSNOMED.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.
                                  306. Observation.component:AverageBloodPressureSNOMED.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
                                  • 308. Observation.component:AverageBloodPressureSNOMED.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.

                                    310. Observation.component:AverageBloodPressureSNOMED.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.
                                    312. Observation.component:AverageBloodPressureSNOMED.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
                                    • 314. Observation.component:AverageBloodPressureSNOMED.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.

                                      Fixed Valuehttp://snomed.info/sct
                                      316. Observation.component:AverageBloodPressureSNOMED.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
                                      318. Observation.component:AverageBloodPressureSNOMED.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.

                                      Fixed Value6797001
                                      320. Observation.component:AverageBloodPressureSNOMED.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.

                                      322. Observation.component:AverageBloodPressureSNOMED.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.

                                      324. Observation.component:AverageBloodPressureSNOMED.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.

                                      326. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity
                                      Slice NamevalueQuantity
                                      Definition

                                      Average blood pressure during one cycle of the heart contracting and relaxing. Estimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.

                                      ShortAverageBloodPressure recorded with UCUM
                                      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
                                      This element is affected by the following invariants: vs-3
                                      TypeQuantity
                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements
                                      1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                      Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, GemiddeldeBloeddruk
                                      328. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.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.
                                      330. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.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
                                      • 332. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.value
                                        Definition

                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                        ShortNumerical value (with implicit precision)
                                        Comments

                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

                                        Precision is handled implicitly in almost all cases of measurement.

                                        334. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.comparator
                                        Definition

                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                        Short< | <= | >= | > - how to understand the value
                                        Comments

                                        This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

                                        Control0..1
                                        BindingThe codes SHALL be taken from QuantityComparator
                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                                        How the Quantity should be understood and represented.

                                        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 a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                        336. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.unit
                                        Definition

                                        A human-readable form of the unit.

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

                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                        338. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.system
                                        Definition

                                        The identification of the system that provides the coded form of the unit.

                                        ShortSystem that defines coded unit form
                                        Control0..1
                                        This element is affected by the following invariants: qty-3
                                        Typeuri
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need to know the system that defines the coded form of the unit.

                                        340. Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.code
                                        Definition

                                        A computer processable form of the unit in some unit representation system.

                                        ShortCoded form of the unit
                                        Comments

                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

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

                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                        Fixed Valuemm[Hg]
                                        342. Observation.component:AverageBloodPressureSNOMED.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, vs-3
                                        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
                                        Must Supporttrue
                                        Requirements

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

                                        344. Observation.component:AverageBloodPressureSNOMED.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
                                        346. Observation.component:AverageBloodPressureSNOMED.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.

                                        348. Observation.component:diastolicEndpoint
                                        Slice NamediastolicEndpoint
                                        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.

                                        ShortDiastolicEndpoint
                                        Comments

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

                                        Control0..1
                                        TypeBackboneElement
                                        Must Supporttrue
                                        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()))
                                        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                        350. Observation.component:diastolicEndpoint.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.
                                        352. Observation.component:diastolicEndpoint.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
                                        354. Observation.component:diastolicEndpoint.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
                                        356. Observation.component:diastolicEndpoint.code
                                        Definition

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

                                        ShortType of component observation (code / type)
                                        Comments

                                        additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                        This identifies the vital sign result type.

                                        TypeCodeableConcept
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

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

                                        Alternate NamesComponent Test, Component Name
                                        358. Observation.component:diastolicEndpoint.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.
                                        360. Observation.component:diastolicEndpoint.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
                                        • 362. Observation.component:diastolicEndpoint.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.

                                          364. Observation.component:diastolicEndpoint.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.
                                          366. Observation.component:diastolicEndpoint.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
                                          • 368. Observation.component:diastolicEndpoint.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.

                                            Fixed Valuehttp://snomed.info/sct
                                            370. Observation.component:diastolicEndpoint.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
                                            372. Observation.component:diastolicEndpoint.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.

                                            Fixed Value85549003
                                            374. Observation.component:diastolicEndpoint.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.

                                            376. Observation.component:diastolicEndpoint.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.

                                            378. Observation.component:diastolicEndpoint.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.

                                            380. Observation.component:diastolicEndpoint.value[x]:valueCodeableConcept
                                            Slice NamevalueCodeableConcept
                                            Definition

                                            Registration of the Korotkoff sound used to measure diastolic pressure with the auscultatory method.

                                            ShortDiastolicEndpoint
                                            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
                                            This element is affected by the following invariants: vs-3
                                            BindingUnless not suitable, these codes SHALL be taken from DiastolischEindpuntCodelijst
                                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.2--20171231000000)

                                            DiastolischEindpuntCodelijst

                                            TypeCodeableConcept
                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements
                                            1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                            Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, DiastolischEindpunt
                                            382. Observation.component:diastolicEndpoint.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, vs-3
                                            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
                                            Must Supporttrue
                                            Requirements

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

                                            384. Observation.component:diastolicEndpoint.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
                                            386. Observation.component:diastolicEndpoint.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.

                                            388. Observation.component:cuffTypeLOINC
                                            Slice NamecuffTypeLOINC
                                            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
                                            Must Supporttrue
                                            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()))
                                            vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                            390. Observation.component:cuffTypeLOINC.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.
                                            392. Observation.component:cuffTypeLOINC.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
                                            394. Observation.component:cuffTypeLOINC.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
                                            396. Observation.component:cuffTypeLOINC.code
                                            Definition

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

                                            ShortType of component observation (code / type)
                                            Comments

                                            additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                                            Control1..1
                                            BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                            (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                            This identifies the vital sign result type.

                                            TypeCodeableConcept
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

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

                                            Alternate NamesComponent Test, Component Name
                                            398. Observation.component:cuffTypeLOINC.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.
                                            400. Observation.component:cuffTypeLOINC.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
                                            • 402. Observation.component:cuffTypeLOINC.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.

                                              404. Observation.component:cuffTypeLOINC.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.
                                              406. Observation.component:cuffTypeLOINC.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
                                              • 408. Observation.component:cuffTypeLOINC.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.

                                                Fixed Valuehttp://loinc.org
                                                410. Observation.component:cuffTypeLOINC.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
                                                412. Observation.component:cuffTypeLOINC.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.

                                                Fixed Value8358-4
                                                414. Observation.component:cuffTypeLOINC.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.

                                                416. Observation.component:cuffTypeLOINC.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.

                                                418. Observation.component:cuffTypeLOINC.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.

                                                420. Observation.component:cuffTypeLOINC.value[x]:valueCodeableConcept
                                                Slice NamevalueCodeableConcept
                                                Definition

                                                The size of the cuff used in the measurement.

                                                ShortCuffType
                                                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
                                                This element is affected by the following invariants: vs-3
                                                BindingUnless not suitable, these codes SHALL be taken from ManchetTypeCodelijst
                                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

                                                ManchetTypeCodelijst

                                                TypeCodeableConcept
                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements
                                                1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, ManchetType
                                                422. Observation.component:cuffTypeLOINC.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, vs-3
                                                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
                                                Must Supporttrue
                                                Requirements

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

                                                424. Observation.component:cuffTypeLOINC.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
                                                426. Observation.component:cuffTypeLOINC.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.

                                                428. Observation.component:cuffTypeSNOMED
                                                Slice NamecuffTypeSNOMED
                                                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
                                                Must Supporttrue
                                                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()))
                                                vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                                430. Observation.component:cuffTypeSNOMED.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.
                                                432. Observation.component:cuffTypeSNOMED.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
                                                434. Observation.component:cuffTypeSNOMED.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
                                                436. Observation.component:cuffTypeSNOMED.code
                                                Definition

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

                                                ShortType of component observation (code / type)
                                                Comments

                                                additional codes that translate or map to this code are allowed. For example a more granular SNOMED code or code that is used locally in a system.

                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                                (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                This identifies the vital sign result type.

                                                TypeCodeableConcept
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

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

                                                Alternate NamesComponent Test, Component Name
                                                438. Observation.component:cuffTypeSNOMED.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.
                                                440. Observation.component:cuffTypeSNOMED.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
                                                • 442. Observation.component:cuffTypeSNOMED.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.

                                                  444. Observation.component:cuffTypeSNOMED.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.
                                                  446. Observation.component:cuffTypeSNOMED.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
                                                  • 448. Observation.component:cuffTypeSNOMED.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.

                                                    Fixed Valuehttp://snomed.info/sct
                                                    450. Observation.component:cuffTypeSNOMED.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
                                                    452. Observation.component:cuffTypeSNOMED.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.

                                                    Fixed Value70665002
                                                    454. Observation.component:cuffTypeSNOMED.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.

                                                    456. Observation.component:cuffTypeSNOMED.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.

                                                    458. Observation.component:cuffTypeSNOMED.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.

                                                    460. Observation.component:cuffTypeSNOMED.value[x]:valueCodeableConcept
                                                    Slice NamevalueCodeableConcept
                                                    Definition

                                                    The size of the cuff used in the measurement.

                                                    ShortCuffType
                                                    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
                                                    This element is affected by the following invariants: vs-3
                                                    BindingUnless not suitable, these codes SHALL be taken from ManchetTypeCodelijst
                                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.3--20171231000000)

                                                    ManchetTypeCodelijst

                                                    TypeCodeableConcept
                                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements
                                                    1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                    Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, ManchetType
                                                    462. Observation.component:cuffTypeSNOMED.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, vs-3
                                                    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
                                                    Must Supporttrue
                                                    Requirements

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

                                                    464. Observation.component:cuffTypeSNOMED.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
                                                    466. Observation.component:cuffTypeSNOMED.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.

                                                    468. Observation.component:positionSNOMED
                                                    Slice NamepositionSNOMED
                                                    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
                                                    Must Supporttrue
                                                    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()))
                                                    vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                                    470. Observation.component:positionSNOMED.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.
                                                    472. Observation.component:positionSNOMED.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
                                                    474. Observation.component:positionSNOMED.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
                                                    476. Observation.component:positionSNOMED.code
                                                    Definition

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

                                                    ShortType of component observation (code / type)
                                                    Control1..1
                                                    BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                                    (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                    This identifies the vital sign result type.

                                                    TypeCodeableConcept
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

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

                                                    478. Observation.component:positionSNOMED.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.
                                                    480. Observation.component:positionSNOMED.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
                                                    • 482. Observation.component:positionSNOMED.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.

                                                      484. Observation.component:positionSNOMED.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.
                                                      486. Observation.component:positionSNOMED.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
                                                      • 488. Observation.component:positionSNOMED.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.

                                                        Fixed Valuehttp://snomed.info/sct
                                                        490. Observation.component:positionSNOMED.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
                                                        492. Observation.component:positionSNOMED.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.

                                                        Fixed Value424724000
                                                        494. Observation.component:positionSNOMED.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.

                                                        496. Observation.component:positionSNOMED.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.

                                                        498. Observation.component:positionSNOMED.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.

                                                        500. Observation.component:positionSNOMED.value[x]:valueCodeableConcept
                                                        Slice NamevalueCodeableConcept
                                                        Definition

                                                        The position of the patient when the blood pressure was measured.

                                                        ShortPosition
                                                        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
                                                        This element is affected by the following invariants: vs-3
                                                        BindingUnless not suitable, these codes SHALL be taken from HoudingCodelijst
                                                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

                                                        HoudingCodelijst

                                                        TypeCodeableConcept
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements
                                                        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                        Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, Houding
                                                        502. Observation.component:positionSNOMED.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, vs-3
                                                        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
                                                        Must Supporttrue
                                                        Requirements

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

                                                        504. Observation.component:positionSNOMED.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
                                                        506. Observation.component:positionSNOMED.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.

                                                        508. Observation.component:positionLOINC
                                                        Slice NamepositionLOINC
                                                        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
                                                        Must Supporttrue
                                                        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()))
                                                        vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                                        510. Observation.component:positionLOINC.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.
                                                        512. Observation.component:positionLOINC.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
                                                        514. Observation.component:positionLOINC.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
                                                        516. Observation.component:positionLOINC.code
                                                        Definition

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

                                                        ShortType of component observation (code / type)
                                                        Control1..1
                                                        BindingUnless not suitable, these codes SHALL be taken from Vital Signs
                                                        (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                        This identifies the vital sign result type.

                                                        TypeCodeableConcept
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

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

                                                        518. Observation.component:positionLOINC.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.
                                                        520. Observation.component:positionLOINC.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
                                                        • 522. Observation.component:positionLOINC.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.

                                                          524. Observation.component:positionLOINC.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.
                                                          526. Observation.component:positionLOINC.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
                                                          • 528. Observation.component:positionLOINC.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.

                                                            Fixed Valuehttp://loinc.org
                                                            530. Observation.component:positionLOINC.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
                                                            532. Observation.component:positionLOINC.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.

                                                            Fixed Value8361-8
                                                            534. Observation.component:positionLOINC.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.

                                                            536. Observation.component:positionLOINC.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.

                                                            538. Observation.component:positionLOINC.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.

                                                            540. Observation.component:positionLOINC.value[x]:valueCodeableConcept
                                                            Slice NamevalueCodeableConcept
                                                            Definition

                                                            The position of the patient when the blood pressure was measured.

                                                            ShortPosition
                                                            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
                                                            This element is affected by the following invariants: vs-3
                                                            BindingUnless not suitable, these codes SHALL be taken from HoudingCodelijst
                                                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.5--20171231000000)

                                                            HoudingCodelijst

                                                            TypeCodeableConcept
                                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements
                                                            1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                            Alternate NamesVital Sign waarde vastgelegd op basis van UCUM-eenheid, Houding
                                                            542. Observation.component:positionLOINC.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, vs-3
                                                            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
                                                            Must Supporttrue
                                                            Requirements

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

                                                            544. Observation.component:positionLOINC.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
                                                            546. Observation.component:positionLOINC.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.