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

Draft as of 2024-04-09

Definitions for the zib-BowelFunction resource profile.

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

0. Observation
2. Observation.extension
SlicingThis element introduces a set of slices on Observation.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Observation.extension:stoma
    Slice Namestoma
    Control0..1
    TypeExtension(Stoma reference for Observation resources) (Extension Type: Reference)
    6. Observation.code
    Definition

    Root concept of the BowelFunction information model. This root concept contains all data elements of the BowelFunction information model.

    ShortBowelFunction
    Alternate NamesDarmFunctie
    8. Observation.code.coding
    Control1..?
    SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • 10. Observation.code.coding:bowelFunctionCoding
      Slice NamebowelFunctionCoding
      Control1..1
      12. Observation.code.coding:bowelFunctionCoding.system
      Control1..?
      Fixed Valuehttp://snomed.info/sct
      14. Observation.code.coding:bowelFunctionCoding.code
      Control1..?
      Fixed Value111989001
      16. Observation.comment
      Definition

      A comment on the BowelFunction.

      ShortComment
      Alternate NamesToelichting
      18. Observation.component
      SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • pattern @ code
      • 20. Observation.component:FecalContinence
        Slice NameFecalContinence
        22. Observation.component:FecalContinence.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "129008009"
          }]
        }
        24. Observation.component:FecalContinence.valueCodeableConcept:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        Fecal continence is the voluntary control over the excretion of feces.

        ShortFecalContinence
        BindingUnless not suitable, these codes SHALL be taken from FecesContinentieCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.1--20171231000000)

        FecesContinentieCodelijst

        TypeCodeableConcept
        Alternate NamesFecesContinentie
        26. Observation.component:Frequency
        Slice NameFrequency
        28. Observation.component:Frequency.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "162098000"
          }]
        }
        30. Observation.component:Frequency.valueQuantity:valueQuantity
        Slice NamevalueQuantity
        Definition

        The defecation frequency.

        ShortFrequency
        TypeQuantity
        Alternate NamesFrequentie
        32. Observation.component:DefecationConsistency
        Slice NameDefecationConsistency
        34. Observation.component:DefecationConsistency.code
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "443172007"
          }]
        }
        36. Observation.component:DefecationConsistency.valueCodeableConcept:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The consistency of the feces indicates the hardness of the stool. The Bristol Stool scale is used to determine this.

        ShortDefecationConsistency
        BindingUnless not suitable, these codes SHALL be taken from DefecatieConsistentieCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.2--20171231000000)

        DefecatieConsistentieCodelijst

        TypeCodeableConcept
        Alternate NamesDefecatieConsistentie
        38. Observation.component:DefecationColor
        Slice NameDefecationColor
        40. Observation.component:DefecationColor.code
        Pattern Value{
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "9397-1"
          }]
        }
        42. Observation.component:DefecationColor.valueCodeableConcept:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The color of feces is possibly relevant for identifying underlying diseases, such as bleeding or biliary tract disease.

        ShortDefecationColor
        BindingUnless not suitable, these codes SHALL be taken from DefecatieKleurCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.5--20171231000000)

        DefecatieKleurCodelijst

        TypeCodeableConcept
        Alternate NamesDefecatieKleur

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

        0. Observation
        Definition

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

        ShortMeasurements and simple assertions
        Comments

        Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc.

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

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

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

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

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

        An Extension


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

        ShortExtensionAdditional Content defined by implementations
        Comments

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

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

          An Extension

          ShortExtension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Stoma reference for Observation resources) (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())
          8. 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
          10. Observation.status
          Definition

          The status of the result value.

          Shortregistered | preliminary | final | amended +
          Comments

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

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

          Codes providing the status of an observation.

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

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

          12. Observation.code
          Definition

          Root concept of the BowelFunction information model. This root concept contains all data elements of the BowelFunction information model.


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

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

          Codes identifying names of simple observations.

          TypeCodeableConcept
          Summarytrue
          Requirements

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

          Alternate NamesName, DarmFunctie
          14. Observation.code.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

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

          Control10..*
          TypeCoding
          Summarytrue
          Requirements

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

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

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

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

            Control10..1*
            TypeCoding
            Summarytrue
            Requirements

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

            18. Observation.code.coding:bowelFunctionCoding.system
            Definition

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

            ShortIdentity of the terminology system
            Comments

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

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

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

            Fixed Valuehttp://snomed.info/sct
            20. Observation.code.coding:bowelFunctionCoding.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

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

            Need to refer to a particular code in the system.

            Fixed Value111989001
            22. Observation.subject
            Definition

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

            ShortWho and/or what this is about
            Comments

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

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

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

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

            24. Observation.comment
            Definition

            A comment on the BowelFunction.


            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
            26. Observation.component
            Definition

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

            ShortComponent results
            Comments

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

            Control0..*
            TypeBackboneElement
            Summarytrue
            Requirements

            Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
            ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • pattern @ code
            • 28. 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
              30. Observation.component.code
              Definition

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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              32. Observation.component:FecalContinence
              Slice NameFecalContinence
              Definition

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

              ShortComponent results
              Comments

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

              Control0..*
              TypeBackboneElement
              Summarytrue
              Requirements

              Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              34. Observation.component:FecalContinence.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
              36. Observation.component:FecalContinence.code
              Definition

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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Pattern Value{
                "coding" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "129008009"
                }]
              }
              38. Observation.component:FecalContinence.value[x]:valueCodeableConcept
              Slice NamevalueCodeableConcept
              Definition

              Fecal continence is the voluntary control over the excretion of feces.


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

              ShortFecalContinenceActual component result
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from For codes, see FecesContinentieCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.1--20171231000000)

              FecesContinentieCodelijst

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

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

              Alternate NamesFecesContinentie
              40. Observation.component:Frequency
              Slice NameFrequency
              Definition

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

              ShortComponent results
              Comments

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

              Control0..*
              TypeBackboneElement
              Summarytrue
              Requirements

              Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

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

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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Pattern Value{
                "coding" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "162098000"
                }]
              }
              46. Observation.component:Frequency.value[x]:valueQuantity
              Slice NamevalueQuantity
              Definition

              The defecation frequency.


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

              ShortFrequencyActual component result
              Comments

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

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

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

              Alternate NamesFrequentie
              48. Observation.component:DefecationConsistency
              Slice NameDefecationConsistency
              Definition

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

              ShortComponent results
              Comments

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

              Control0..*
              TypeBackboneElement
              Summarytrue
              Requirements

              Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

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

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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Pattern Value{
                "coding" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "443172007"
                }]
              }
              54. Observation.component:DefecationConsistency.value[x]:valueCodeableConcept
              Slice NamevalueCodeableConcept
              Definition

              The consistency of the feces indicates the hardness of the stool. The Bristol Stool scale is used to determine this.


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

              ShortDefecationConsistencyActual component result
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from For codes, see DefecatieConsistentieCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.2--20171231000000)

              DefecatieConsistentieCodelijst

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

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

              Alternate NamesDefecatieConsistentie
              56. Observation.component:DefecationColor
              Slice NameDefecationColor
              Definition

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

              ShortComponent results
              Comments

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

              Control0..*
              TypeBackboneElement
              Summarytrue
              Requirements

              Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              58. Observation.component:DefecationColor.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
              60. Observation.component:DefecationColor.code
              Definition

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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Pattern Value{
                "coding" : [{
                  "system" : "http://loinc.org",
                  "code" : "9397-1"
                }]
              }
              62. Observation.component:DefecationColor.value[x]:valueCodeableConcept
              Slice NamevalueCodeableConcept
              Definition

              The color of feces is possibly relevant for identifying underlying diseases, such as bleeding or biliary tract disease.


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

              ShortDefecationColorActual component result
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from For codes, see DefecatieKleurCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.5--20171231000000)

              DefecatieKleurCodelijst

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

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

              Alternate NamesDefecatieKleur

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

              0. Observation
              Definition

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

              ShortMeasurements and simple assertions
              Comments

              Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc.

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

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

              ShortLogical id of this artifact
              Comments

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

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

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

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

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

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

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

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

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

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

              A human language.

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

              A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

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

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

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

              An Extension

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

                An Extension

                ShortExtension
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Stoma reference for Observation resources) (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())
                18. 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
                20. 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.

                22. 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
                24. Observation.status
                Definition

                The status of the result value.

                Shortregistered | preliminary | final | amended +
                Comments

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

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

                Codes providing the status of an observation.

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

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

                26. Observation.category
                Definition

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

                ShortClassification of type of observation
                Comments

                In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

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

                Codes for high level observation categories.

                TypeCodeableConcept
                Requirements

                Used for filtering what observations are retrieved and displayed.

                28. Observation.code
                Definition

                Root concept of the BowelFunction information model. This root concept contains all data elements of the BowelFunction information model.

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

                Codes identifying names of simple observations.

                TypeCodeableConcept
                Summarytrue
                Requirements

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

                Alternate NamesName, DarmFunctie
                30. 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.
                32. 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
                • 34. Observation.code.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

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

                  Control1..*
                  TypeCoding
                  Summarytrue
                  Requirements

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

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

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

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

                    Control1..1
                    TypeCoding
                    Summarytrue
                    Requirements

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

                    38. Observation.code.coding:bowelFunctionCoding.id
                    Definition

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

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

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

                      ShortIdentity of the terminology system
                      Comments

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

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

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

                      Fixed Valuehttp://snomed.info/sct
                      44. Observation.code.coding:bowelFunctionCoding.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
                      46. Observation.code.coding:bowelFunctionCoding.code
                      Definition

                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

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

                      Need to refer to a particular code in the system.

                      Fixed Value111989001
                      48. Observation.code.coding:bowelFunctionCoding.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.

                      50. Observation.code.coding:bowelFunctionCoding.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.

                      52. 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.

                      54. Observation.subject
                      Definition

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

                      ShortWho and/or what this is about
                      Comments

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

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

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

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

                      56. 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
                      58. Observation.effective[x]
                      Definition

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

                      ShortClinically relevant time/time-period for observation
                      Comments

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

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

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

                      Alternate NamesOccurrence
                      60. 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
                      62. Observation.performer
                      Definition

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

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

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

                      64. 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.
                      66. 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
                      • 68. Observation.performer.extension:practitionerRole
                        Slice NamepractitionerRole
                        Definition

                        Optional Extension Element - found in all resources.

                        ShortOptional Extensions Element
                        Control0..1
                        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                        70. 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
                        72. 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
                        74. 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
                        76. Observation.value[x]
                        Definition

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

                        ShortActual result
                        Comments

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

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

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

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

                        78. Observation.dataAbsentReason
                        Definition

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

                        ShortWhy the result is missing
                        Comments

                        Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

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

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

                        TypeCodeableConcept
                        Requirements

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

                        80. 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
                        82. Observation.comment
                        Definition

                        A comment on the BowelFunction.

                        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
                        84. 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
                        86. 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.

                        88. 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)
                        90. Observation.device
                        Definition

                        The device used to generate the observation data.

                        Short(Measurement) Device
                        Comments

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

                        Control0..1
                        TypeReference(Device, DeviceMetric)
                        92. 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())
                        94. 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.
                        96. 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
                        98. 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
                        100. 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)
                        102. 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)
                        104. 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.

                        106. 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.

                        108. 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.

                        110. 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
                        112. Observation.related
                        Definition

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

                        ShortResource related to this observation
                        Comments

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

                        Control0..*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        114. 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.
                        116. 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
                        118. 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
                        120. Observation.related.type
                        Definition

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

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

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

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

                        Codes specifying how two observations are related.

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

                        A relationship type SHOULD be provided.

                        122. Observation.related.target
                        Definition

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

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

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

                        ShortComponent results
                        Comments

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

                        Control0..*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

                        Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Observation.component. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • pattern @ code
                        • 126. 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.
                          128. 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
                          130. 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
                          132. Observation.component.code
                          Definition

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

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          134. Observation.component.value[x]
                          Definition

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

                          ShortActual component result
                          Comments

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

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

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

                          136. Observation.component.dataAbsentReason
                          Definition

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

                          ShortWhy the component result is missing
                          Comments

                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

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

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

                          TypeCodeableConcept
                          Requirements

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

                          138. 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
                          140. 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.

                          142. Observation.component:FecalContinence
                          Slice NameFecalContinence
                          Definition

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

                          ShortComponent results
                          Comments

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

                          Control0..*
                          TypeBackboneElement
                          Summarytrue
                          Requirements

                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          144. Observation.component:FecalContinence.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.
                          146. Observation.component:FecalContinence.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
                          148. Observation.component:FecalContinence.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
                          150. Observation.component:FecalContinence.code
                          Definition

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

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://snomed.info/sct",
                              "code" : "129008009"
                            }]
                          }
                          152. Observation.component:FecalContinence.value[x]:valueCodeableConcept
                          Slice NamevalueCodeableConcept
                          Definition

                          Fecal continence is the voluntary control over the excretion of feces.

                          ShortFecalContinence
                          Comments

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

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from FecesContinentieCodelijst
                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.1--20171231000000)

                          FecesContinentieCodelijst

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

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

                          Alternate NamesFecesContinentie
                          154. Observation.component:FecalContinence.dataAbsentReason
                          Definition

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

                          ShortWhy the component result is missing
                          Comments

                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

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

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

                          TypeCodeableConcept
                          Requirements

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

                          156. Observation.component:FecalContinence.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
                          158. Observation.component:FecalContinence.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.

                          160. Observation.component:Frequency
                          Slice NameFrequency
                          Definition

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

                          ShortComponent results
                          Comments

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

                          Control0..*
                          TypeBackboneElement
                          Summarytrue
                          Requirements

                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

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

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

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://snomed.info/sct",
                              "code" : "162098000"
                            }]
                          }
                          170. Observation.component:Frequency.value[x]:valueQuantity
                          Slice NamevalueQuantity
                          Definition

                          The defecation frequency.

                          ShortFrequency
                          Comments

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

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

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

                          Alternate NamesFrequentie
                          172. Observation.component:Frequency.dataAbsentReason
                          Definition

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

                          ShortWhy the component result is missing
                          Comments

                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

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

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

                          TypeCodeableConcept
                          Requirements

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

                          174. Observation.component:Frequency.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
                          176. Observation.component:Frequency.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.

                          178. Observation.component:DefecationConsistency
                          Slice NameDefecationConsistency
                          Definition

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

                          ShortComponent results
                          Comments

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

                          Control0..*
                          TypeBackboneElement
                          Summarytrue
                          Requirements

                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          180. Observation.component:DefecationConsistency.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.
                          182. Observation.component:DefecationConsistency.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
                          184. Observation.component:DefecationConsistency.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
                          186. Observation.component:DefecationConsistency.code
                          Definition

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

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://snomed.info/sct",
                              "code" : "443172007"
                            }]
                          }
                          188. Observation.component:DefecationConsistency.value[x]:valueCodeableConcept
                          Slice NamevalueCodeableConcept
                          Definition

                          The consistency of the feces indicates the hardness of the stool. The Bristol Stool scale is used to determine this.

                          ShortDefecationConsistency
                          Comments

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

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from DefecatieConsistentieCodelijst
                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.2--20171231000000)

                          DefecatieConsistentieCodelijst

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

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

                          Alternate NamesDefecatieConsistentie
                          190. Observation.component:DefecationConsistency.dataAbsentReason
                          Definition

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

                          ShortWhy the component result is missing
                          Comments

                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

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

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

                          TypeCodeableConcept
                          Requirements

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

                          192. Observation.component:DefecationConsistency.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
                          194. Observation.component:DefecationConsistency.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.

                          196. Observation.component:DefecationColor
                          Slice NameDefecationColor
                          Definition

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

                          ShortComponent results
                          Comments

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

                          Control0..*
                          TypeBackboneElement
                          Summarytrue
                          Requirements

                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

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

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

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://loinc.org",
                              "code" : "9397-1"
                            }]
                          }
                          206. Observation.component:DefecationColor.value[x]:valueCodeableConcept
                          Slice NamevalueCodeableConcept
                          Definition

                          The color of feces is possibly relevant for identifying underlying diseases, such as bleeding or biliary tract disease.

                          ShortDefecationColor
                          Comments

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

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from DefecatieKleurCodelijst
                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.15.5--20171231000000)

                          DefecatieKleurCodelijst

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

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

                          Alternate NamesDefecatieKleur
                          208. Observation.component:DefecationColor.dataAbsentReason
                          Definition

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

                          ShortWhy the component result is missing
                          Comments

                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

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

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

                          TypeCodeableConcept
                          Requirements

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

                          210. Observation.component:DefecationColor.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
                          212. Observation.component:DefecationColor.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.