Nictiz FHIR NL STU3 Zib2017
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Resource Profile: Zib BodyHeight - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-BodyHeight resource profile.

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

0. Observation
Definition

The FHIR BodyHeight profile sets a minimum expectations for the Observation Resource to record, search and fetch the body height associated with a patient.

ShortBodyHeight
Alternate NamesLichaamslengte
2. Observation.code
Definition

A LOINC code is used to code this observation and to specify the position of the body height measurement. The HCIM concept Position has two SNOMED codes that map to LOINC codes for this element, namely: * SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to LOINC code 8308-9. * SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to LOINC code 8306-3.

4. Observation.code.coding:bodyHeightCodeStanding
Slice NamebodyHeightCodeStanding
Comments

SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to this slice with LOINC code 8308-9

Control0..1
6. Observation.code.coding:bodyHeightCodeStanding.system
Fixed Valuehttp://loinc.org
8. Observation.code.coding:bodyHeightCodeStanding.code
Fixed Value8308-9
10. Observation.code.coding:bodyHeightCodeLying
Slice NamebodyHeightCodeLying
Comments

SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to this slice with LOINC code 8306-3

Control0..1
12. Observation.code.coding:bodyHeightCodeLying.system
Fixed Valuehttp://loinc.org
14. Observation.code.coding:bodyHeightCodeLying.code
Fixed Value8306-3
16. Observation.subject
ShortPatient
Alternate NamesPatiënt
18. Observation.effective[x]
Definition

Date and if possible time of body height measurement.

ShortHeightDateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Alternate NamesLengteDatumTijd
20. Observation.valueQuantity:valueQuantity
Slice NamevalueQuantity
Definition

The element contains the value of the measured body height. Body height is the height of the human body from heel to scalp, generally measured when standing. Body height is measured in a stretched, horizontal position for very small children or patients that are unable to stand.

ShortHeightValue recorded with UCUM
Control1..?
Alternate NamesLengteWaarde
22. Observation.comment
Definition

Comment on the body height measurement.

ShortComment
Alternate NamesToelichting

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

0. Observation
Definition

The FHIR BodyHeight profile sets a minimum expectations for the Observation Resource to record, search and fetch the body height associated with a patient.


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

ShortBodyHeightMeasurements 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, FHIR Lichaamslengte-profiel, Lichaamslengte
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.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.

8. 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())
10. Observation.code
Definition

A LOINC code is used to code this observation and to specify the position of the body height measurement. The HCIM concept Position has two SNOMED codes that map to LOINC codes for this element, namely: * SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to LOINC code 8308-9. * SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to LOINC code 8306-3.


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

ShortBody HeightType of 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
  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, Lichaamslengte
12. Observation.code.coding
Definition

A reference to a code defined by a terminology system.

ShortCode defined by a terminology system
Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

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.

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

    16. Observation.code.coding:bodyHeightCodeStanding
    Slice NamebodyHeightCodeStanding
    Definition

    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

    SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to this slice with LOINC code 8308-9


    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control0..1*
    TypeCoding
    Summarytrue
    Requirements

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

    18. Observation.code.coding:bodyHeightCodeStanding.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
    20. Observation.code.coding:bodyHeightCodeStanding.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 Value8308-9
    22. Observation.code.coding:bodyHeightCodeLying
    Slice NamebodyHeightCodeLying
    Definition

    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

    SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to this slice with LOINC code 8306-3


    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control0..1*
    TypeCoding
    Summarytrue
    Requirements

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

    24. Observation.code.coding:bodyHeightCodeLying.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
    26. Observation.code.coding:bodyHeightCodeLying.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 Value8306-3
    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.

    ShortPatientWho 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.

    Alternate NamesPatiënt
    30. Observation.effective[x]
    Definition

    Date and if possible time of body height measurement.


    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.

    ShortHeightDateTimeClinically 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, LengteDatumTijd
    32. 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.

    34. 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())
    36. 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
    • 38. Observation.value[x]:valueQuantity
      Slice NamevalueQuantity
      Definition

      The element contains the value of the measured body height. Body height is the height of the human body from heel to scalp, generally measured when standing. Body height is measured in a stretched, horizontal position for very small children or patients that are unable to stand.


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

      ShortHeightValue 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.

      Control10..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, LengteWaarde
      40. 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.

      42. 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
      44. 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.

      46. 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
      48. 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
      BindingThe codes SHALL be taken from For codes, see Body Length Units
      (required to http://hl7.org/fhir/ValueSet/ucum-bodylength)

      Common UCUM units for Body Length measures such as Body Height and Head Circumference

      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.
      50. 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.

      52. Observation.comment
      Definition

      Comment on the body height measurement.


      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
      54. 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()))
      56. 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
      58. 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
      60. 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
      62. 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()))
      64. 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
      66. 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.

      68. 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
      70. 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.

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

      0. Observation
      Definition

      The FHIR BodyHeight profile sets a minimum expectations for the Observation Resource to record, search and fetch the body height associated with a patient.

      ShortBodyHeight
      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, FHIR Lichaamslengte-profiel, Lichaamslengte
      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

      A LOINC code is used to code this observation and to specify the position of the body height measurement. The HCIM concept Position has two SNOMED codes that map to LOINC codes for this element, namely: * SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to LOINC code 8308-9. * SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to LOINC code 8306-3.

      ShortBody Height
      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
      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, Lichaamslengte
      28. Observation.code.id
      Definition

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

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

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

      ShortAdditional Content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        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.

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

          36. Observation.code.coding:BodyHeightCode.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.
          38. Observation.code.coding:BodyHeightCode.extension
          Definition

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

          ShortAdditional Content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Alternate Namesextensions, user content
          SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 40. Observation.code.coding:BodyHeightCode.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
            42. Observation.code.coding:BodyHeightCode.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
            44. Observation.code.coding:BodyHeightCode.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 Value8302-2
            46. Observation.code.coding:BodyHeightCode.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.

            48. Observation.code.coding:BodyHeightCode.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.

            50. Observation.code.coding:bodyHeightCodeStanding
            Slice NamebodyHeightCodeStanding
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

            SNOMED CT code 10904000 - Orthostatic body position (Staande positie) maps to this slice with LOINC code 8308-9

            Control0..1
            TypeCoding
            Summarytrue
            Requirements

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

            52. Observation.code.coding:bodyHeightCodeStanding.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.
            54. Observation.code.coding:bodyHeightCodeStanding.extension
            Definition

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

            ShortAdditional Content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 56. Observation.code.coding:bodyHeightCodeStanding.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
              58. Observation.code.coding:bodyHeightCodeStanding.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
              60. Observation.code.coding:bodyHeightCodeStanding.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 Value8308-9
              62. Observation.code.coding:bodyHeightCodeStanding.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.

              64. Observation.code.coding:bodyHeightCodeStanding.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.

              66. Observation.code.coding:bodyHeightCodeLying
              Slice NamebodyHeightCodeLying
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              SNOMED CT code 102538003 - Recumbent body position (Liggende positie) maps to this slice with LOINC code 8306-3

              Control0..1
              TypeCoding
              Summarytrue
              Requirements

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

              68. Observation.code.coding:bodyHeightCodeLying.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.
              70. Observation.code.coding:bodyHeightCodeLying.extension
              Definition

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

              ShortAdditional Content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 72. Observation.code.coding:bodyHeightCodeLying.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
                74. Observation.code.coding:bodyHeightCodeLying.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
                76. Observation.code.coding:bodyHeightCodeLying.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 Value8306-3
                78. Observation.code.coding:bodyHeightCodeLying.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.

                80. Observation.code.coding:bodyHeightCodeLying.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.

                82. Observation.code.text
                Definition

                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                ShortPlain text representation of the concept
                Comments

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

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

                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                84. 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.

                ShortPatient
                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.

                Alternate NamesPatiënt
                86. 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
                88. Observation.effective[x]
                Definition

                Date and if possible time of body height measurement.

                ShortHeightDateTime
                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, LengteDatumTijd
                90. 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
                92. 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.

                94. 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.
                96. 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
                • 98. 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())
                  100. 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
                  102. 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
                  104. 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
                  106. 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
                  • 108. Observation.value[x]:valueQuantity
                    Slice NamevalueQuantity
                    Definition

                    The element contains the value of the measured body height. Body height is the height of the human body from heel to scalp, generally measured when standing. Body height is measured in a stretched, horizontal position for very small children or patients that are unable to stand.

                    ShortHeightValue 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.

                    Control1..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, LengteWaarde
                    110. 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.
                    112. 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
                    • 114. 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.

                      116. 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
                      118. 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.

                      120. 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
                      122. 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
                      BindingThe codes SHALL be taken from Body Length Units
                      (required to http://hl7.org/fhir/ValueSet/ucum-bodylength)

                      Common UCUM units for Body Length measures such as Body Height and Head Circumference

                      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.
                      124. 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.

                      126. 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
                      128. Observation.comment
                      Definition

                      Comment on the body height measurement.

                      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
                      130. Observation.bodySite
                      Definition

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

                      ShortObserved body part
                      Comments

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

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

                      Codes describing anatomical locations. May include laterality.

                      TypeCodeableConcept
                      132. Observation.method
                      Definition

                      Indicates the mechanism used to perform the observation.

                      ShortHow it was done
                      Comments

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

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

                      Methods for simple observations.

                      TypeCodeableConcept
                      Requirements

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

                      134. 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)
                      136. 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)
                      138. 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())
                      140. 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.
                      142. 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
                      144. 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
                      146. 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)
                      148. 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)
                      150. 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.

                      152. 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.

                      154. 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.

                      156. 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
                      158. 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()))
                      160. 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.
                      162. 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
                      164. 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
                      166. 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
                      168. 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
                      170. 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())
                      172. 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.
                      174. 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
                      176. 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
                      178. 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.

                      180. 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
                      182. 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.

                      184. 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
                      186. 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.