Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build

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

Resource Profile: Zib ChecklistPainBehaviour - Detailed Descriptions

Active as of 2025-09-22

Definitions for the zib-ChecklistPainBehaviour resource profile.

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

0. Observation
ShortChecklistPainBehaviour
Alternate NamesChecklistPijnGedrag
2. Observation.code
4. Observation.code.coding
Control1..?
SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ code
  • 6. Observation.code.coding:ChecklistPainBehaviourCode
    Slice NameChecklistPainBehaviourCode
    Control1..1
    8. Observation.code.coding:ChecklistPainBehaviourCode.system
    Control1..?
    Fixed Valuehttp://snomed.info/sct
    10. Observation.code.coding:ChecklistPainBehaviourCode.code
    Control1..?
    Fixed Value108331000146104
    12. Observation.code.coding:ChecklistPainBehaviourCode.display
    Default ValuePain Behaviour Checklist
    14. Observation.effectiveDateTime:effectiveDateTime
    Slice NameeffectiveDateTime
    Definition

    The date and time at which the CPB score was determined.

    ShortScoreDateTime
    Control1..?
    TypedateTime
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Alternate NamesScoreDatumTijd
    16. Observation.value[x]:valueQuantity
    Slice NamevalueQuantity
    Definition

    The total score is the sum of all the individual scores. The total score has a range from 0 - 10.

    ShortTotalScore
    TypeQuantity
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Alternate NamesTotaalScore
    Min Value{ "value" : 0 }
    Max Value{ "value" : 10 }
    18. Observation.comment
    ShortComment
    Alternate NamesToelichting
    20. Observation.component
    SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ code
    • 22. Observation.component:Face
      Slice NameFace
      Control0..1
      24. Observation.component:Face.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.3"
        }]
      }
      26. Observation.component:Face.code.coding
      28. Observation.component:Face.code.coding.display
      Default ValueFace
      30. Observation.component:Face.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Tense face; one or more muscles in the face are tensed.

      ShortFace
      TypeQuantity
      Alternate NamesGezicht
      32. Observation.component:Face.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      34. Observation.component:Mouth
      Slice NameMouth
      Control0..1
      36. Observation.component:Mouth.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.4"
        }]
      }
      38. Observation.component:Mouth.code.coding
      40. Observation.component:Mouth.code.coding.display
      Default ValueMouth
      42. Observation.component:Mouth.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Deeper naso-labial furrow; the line between the nose and mouth (naso-labial furrow) is deeper and aside.

      ShortMouth
      TypeQuantity
      Alternate NamesMond
      44. Observation.component:Mouth.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      46. Observation.component:Grimace
      Slice NameGrimace
      Control0..1
      48. Observation.component:Grimace.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.5"
        }]
      }
      50. Observation.component:Grimace.code.coding
      52. Observation.component:Grimace.code.coding.display
      Default ValueGrimace
      54. Observation.component:Grimace.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Grimace; the co-occurrence of: furrowed eyebrows; eyes that are composed or pinched; a deeper line between the nose and mouth; opened mouth.

      ShortGrimace
      TypeQuantity
      Alternate NamesGrimas
      56. Observation.component:Grimace.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      58. Observation.component:LookingSad
      Slice NameLookingSad
      Control0..1
      60. Observation.component:LookingSad.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.6"
        }]
      }
      62. Observation.component:LookingSad.code.coding
      64. Observation.component:LookingSad.code.coding.display
      Default ValueLooking sad
      66. Observation.component:LookingSad.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Looking sad, almost in tears: eyebrows which have been pulled up laterally on the inner sides; wrinkles in the forehead, especially over the nose; eyes are squeezed; mouth drawn down possibly combined with a pout.

      ShortLookingSad
      TypeQuantity
      Alternate NamesVerdrietigeBlik
      68. Observation.component:LookingSad.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      70. Observation.component:Eyes
      Slice NameEyes
      Control0..1
      72. Observation.component:Eyes.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.7"
        }]
      }
      74. Observation.component:Eyes.code.coding
      76. Observation.component:Eyes.code.coding.display
      Default ValueEyes
      78. Observation.component:Eyes.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Eyes squeezed. Note: Do NOT score as present when the child is blinking or when the eyes are still closed without blinking.

      ShortEyes
      TypeQuantity
      Alternate NamesOgen
      80. Observation.component:Eyes.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      82. Observation.component:Panic
      Slice NamePanic
      Control0..1
      84. Observation.component:Panic.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.8"
        }]
      }
      86. Observation.component:Panic.code.coding
      88. Observation.component:Panic.code.coding.display
      Default ValuePanic
      90. Observation.component:Panic.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Panics, panic attack: an extreme form of anxiety which manifests itself in random restless body movements or violent resistance. This may be associated with an anxious look characterized by large widely opened eyes and eyebrows which are on the inner side raised up.

      ShortPanic
      TypeQuantity
      Alternate NamesPaniek
      92. Observation.component:Panic.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      94. Observation.component:Moaning
      Slice NameMoaning
      Control0..1
      96. Observation.component:Moaning.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.9"
        }]
      }
      98. Observation.component:Moaning.code.coding
      100. Observation.component:Moaning.code.coding.display
      Default ValueMoaning
      102. Observation.component:Moaning.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Moaning, groaning; monotonous sound on plaintive tone

      ShortMoaning
      TypeQuantity
      Alternate NamesKreunen
      104. Observation.component:Moaning.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      106. Observation.component:Cry
      Slice NameCry
      Control0..1
      108. Observation.component:Cry.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.10"
        }]
      }
      110. Observation.component:Cry.code.coding
      112. Observation.component:Cry.code.coding.display
      Default ValueCry
      114. Observation.component:Cry.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Cries softly; crying is accompanied by a shocking breath.

      ShortCry
      TypeQuantity
      Alternate NamesHuilen
      116. Observation.component:Cry.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      118. Observation.component:SoundsOfRestlessness
      Slice NameSoundsOfRestlessness
      Control0..1
      120. Observation.component:SoundsOfRestlessness.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.11"
        }]
      }
      122. Observation.component:SoundsOfRestlessness.code.coding
      124. Observation.component:SoundsOfRestlessness.code.coding.display
      Default ValueSounds of restlessness
      126. Observation.component:SoundsOfRestlessness.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Penetrating sounds of restlessness: sudden or longer lasting intense cries or verbal expressions of pain, such as "au" or 'you hurt me'

      ShortSoundsOfRestlessness
      TypeQuantity
      Alternate NamesOnrustigeGeluiden
      128. Observation.component:SoundsOfRestlessness.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1
      130. Observation.component:Tears
      Slice NameTears
      Control0..1
      132. Observation.component:Tears.code
      Pattern Value{
        "coding" : [{
          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
          "code" : "12.17.12"
        }]
      }
      134. Observation.component:Tears.code.coding
      136. Observation.component:Tears.code.coding.display
      Default ValueTears
      138. Observation.component:Tears.valueQuantity:valueQuantity
      Slice NamevalueQuantity
      Definition

      Tears: child produces tears in at least one eye, so more than just watery eyes.

      ShortTears
      TypeQuantity
      Alternate NamesTranen
      140. Observation.component:Tears.valueQuantity:valueQuantity.value
      Min Value0
      Max Value1

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

      0. Observation
      Definition

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

      ShortChecklistPainBehaviourMeasurements 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, ChecklistPijnGedrag
      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.modifierExtension
      Definition

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

      ShortExtensions that cannot be ignored
      Comments

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

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

      The status of the result value.

      Shortregistered | preliminary | final | amended +
      Comments

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

      Control1..1
      BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|3.0.2
      (required to http://hl7.org/fhir/ValueSet/observation-status|3.0.2)

      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.

      8. Observation.code
      Definition

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

      ShortType of observation (code / type)
      Control1..1
      BindingFor example codes, see LOINC Codeshttp://hl7.org/fhir/ValueSet/observation-codes|3.0.2
      (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

      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
      10. 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 areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ code
      • 12. Observation.code.coding:ChecklistPainBehaviourCode
        Slice NameChecklistPainBehaviourCode
        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.

        14. Observation.code.coding:ChecklistPainBehaviourCode.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
        16. Observation.code.coding:ChecklistPainBehaviourCode.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 Value108331000146104
        18. Observation.code.coding:ChecklistPainBehaviourCode.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.

        20. 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.

        22. 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.

        Control10..1
        TypedateTime, Period
        [x] NoteSeeChoice of Data Typesfor 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
        SlicingThis element introduces a set of slices on Observation.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 24. Observation.effective[x]:effectiveDateTime
          Slice NameeffectiveDateTime
          Definition

          The date and time at which the CPB score was determined.


          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.

          ShortScoreDateTimeClinically relevant time/time-period for observation
          Comments

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

          Control10..1
          TypedateTime, Period
          [x] NoteSeeChoice of Data Typesfor 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, ScoreDatumTijd
          26. 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] NoteSeeChoice of Data Typesfor 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.

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

            The total score is the sum of all the individual scores. The total score has a range from 0 - 10.


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

            ShortTotalScoreActual result
            Comments

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

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

            Control0..1
            This element is affected by the following invariants: obs-7
            TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
            [x] NoteSeeChoice of Data Typesfor 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 NamesTotaalScore
            Min Value{ "value" : 0 }
            Max Value{ "value" : 10 }
            30. Observation.comment
            Definition

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

            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
            32. 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 areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ code
            • 34. 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
              36. 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|3.0.2
              (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              38. Observation.component:Face
              Slice NameFace
              Definition

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

              ShortComponent results
              Comments

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

              Control0..1*
              TypeBackboneElement
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              40. Observation.component:Face.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
              42. Observation.component:Face.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|3.0.2
              (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Pattern Value{
                "coding" : [{
                  "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                  "code" : "12.17.3"
                }]
              }
              44. Observation.component:Face.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] NoteSeeChoice of Data Typesfor 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.

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

                Tense face; one or more muscles in the face are tensed.


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

                ShortFaceActual 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] NoteSeeChoice of Data Typesfor 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 NamesGezicht
                48. Observation.component:Face.value[x]:valueQuantity.value
                Definition

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

                ShortNumerical value (with implicit precision)
                Comments

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

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

                Precision is handled implicitly in almost all cases of measurement.

                Min Value0
                Max Value1
                50. Observation.component:Face.value[x]:valueQuantity.comparator
                Definition

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

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

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

                Control0..1
                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                How the Quantity should be understood and represented.

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

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

                Meaning if MissingIf there is no comparator, then there is no modification of the value
                52. Observation.component:Mouth
                Slice NameMouth
                Definition

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

                ShortComponent results
                Comments

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

                Control0..1*
                TypeBackboneElement
                Summarytrue
                Requirements

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

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

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

                ShortExtensions that cannot be ignored
                Comments

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

                Control0..*
                TypeExtension
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Summarytrue
                Alternate Namesextensions, user content, modifiers
                56. Observation.component:Mouth.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|3.0.2
                (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                Codes identifying names of simple observations.

                TypeCodeableConcept
                Summarytrue
                Requirements

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

                Pattern Value{
                  "coding" : [{
                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                    "code" : "12.17.4"
                  }]
                }
                58. Observation.component:Mouth.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] NoteSeeChoice of Data Typesfor 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.

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

                  Deeper naso-labial furrow; the line between the nose and mouth (naso-labial furrow) is deeper and aside.


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

                  ShortMouthActual 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] NoteSeeChoice of Data Typesfor 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 NamesMond
                  62. Observation.component:Mouth.value[x]:valueQuantity.value
                  Definition

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

                  ShortNumerical value (with implicit precision)
                  Comments

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

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

                  Precision is handled implicitly in almost all cases of measurement.

                  Min Value0
                  Max Value1
                  64. Observation.component:Mouth.value[x]:valueQuantity.comparator
                  Definition

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

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

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

                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                  How the Quantity should be understood and represented.

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

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

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  66. Observation.component:Grimace
                  Slice NameGrimace
                  Definition

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

                  ShortComponent results
                  Comments

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

                  Control0..1*
                  TypeBackboneElement
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  68. Observation.component:Grimace.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
                  70. Observation.component:Grimace.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|3.0.2
                  (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                  Codes identifying names of simple observations.

                  TypeCodeableConcept
                  Summarytrue
                  Requirements

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

                  Pattern Value{
                    "coding" : [{
                      "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                      "code" : "12.17.5"
                    }]
                  }
                  72. Observation.component:Grimace.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] NoteSeeChoice of Data Typesfor 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.

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

                    Grimace; the co-occurrence of: furrowed eyebrows; eyes that are composed or pinched; a deeper line between the nose and mouth; opened mouth.


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

                    ShortGrimaceActual 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] NoteSeeChoice of Data Typesfor 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 NamesGrimas
                    76. Observation.component:Grimace.value[x]:valueQuantity.value
                    Definition

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

                    ShortNumerical value (with implicit precision)
                    Comments

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

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

                    Precision is handled implicitly in almost all cases of measurement.

                    Min Value0
                    Max Value1
                    78. Observation.component:Grimace.value[x]:valueQuantity.comparator
                    Definition

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

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

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

                    Control0..1
                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                    How the Quantity should be understood and represented.

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

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

                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                    80. Observation.component:LookingSad
                    Slice NameLookingSad
                    Definition

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

                    ShortComponent results
                    Comments

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

                    Control0..1*
                    TypeBackboneElement
                    Summarytrue
                    Requirements

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

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

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

                    ShortExtensions that cannot be ignored
                    Comments

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

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Summarytrue
                    Alternate Namesextensions, user content, modifiers
                    84. Observation.component:LookingSad.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|3.0.2
                    (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

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

                    Pattern Value{
                      "coding" : [{
                        "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                        "code" : "12.17.6"
                      }]
                    }
                    86. Observation.component:LookingSad.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] NoteSeeChoice of Data Typesfor 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.

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

                      Looking sad, almost in tears: eyebrows which have been pulled up laterally on the inner sides; wrinkles in the forehead, especially over the nose; eyes are squeezed; mouth drawn down possibly combined with a pout.


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

                      ShortLookingSadActual 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] NoteSeeChoice of Data Typesfor 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 NamesVerdrietigeBlik
                      90. Observation.component:LookingSad.value[x]:valueQuantity.value
                      Definition

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

                      ShortNumerical value (with implicit precision)
                      Comments

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

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

                      Precision is handled implicitly in almost all cases of measurement.

                      Min Value0
                      Max Value1
                      92. Observation.component:LookingSad.value[x]:valueQuantity.comparator
                      Definition

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

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

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

                      Control0..1
                      BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                      How the Quantity should be understood and represented.

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

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

                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                      94. Observation.component:Eyes
                      Slice NameEyes
                      Definition

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

                      ShortComponent results
                      Comments

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

                      Control0..1*
                      TypeBackboneElement
                      Summarytrue
                      Requirements

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

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

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

                      ShortExtensions that cannot be ignored
                      Comments

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

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                      Summarytrue
                      Alternate Namesextensions, user content, modifiers
                      98. Observation.component:Eyes.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|3.0.2
                      (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                      Codes identifying names of simple observations.

                      TypeCodeableConcept
                      Summarytrue
                      Requirements

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

                      Pattern Value{
                        "coding" : [{
                          "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                          "code" : "12.17.7"
                        }]
                      }
                      100. Observation.component:Eyes.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] NoteSeeChoice of Data Typesfor 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.

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

                        Eyes squeezed. Note: Do NOT score as present when the child is blinking or when the eyes are still closed without blinking.


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

                        ShortEyesActual 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] NoteSeeChoice of Data Typesfor 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 NamesOgen
                        104. Observation.component:Eyes.value[x]:valueQuantity.value
                        Definition

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

                        ShortNumerical value (with implicit precision)
                        Comments

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

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

                        Precision is handled implicitly in almost all cases of measurement.

                        Min Value0
                        Max Value1
                        106. Observation.component:Eyes.value[x]:valueQuantity.comparator
                        Definition

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

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

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

                        Control0..1
                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                        How the Quantity should be understood and represented.

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

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

                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                        108. Observation.component:Panic
                        Slice NamePanic
                        Definition

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

                        ShortComponent results
                        Comments

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

                        Control0..1*
                        TypeBackboneElement
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        110. Observation.component:Panic.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
                        112. Observation.component:Panic.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|3.0.2
                        (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Summarytrue
                        Requirements

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

                        Pattern Value{
                          "coding" : [{
                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                            "code" : "12.17.8"
                          }]
                        }
                        114. Observation.component:Panic.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] NoteSeeChoice of Data Typesfor 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.

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

                          Panics, panic attack: an extreme form of anxiety which manifests itself in random restless body movements or violent resistance. This may be associated with an anxious look characterized by large widely opened eyes and eyebrows which are on the inner side raised up.


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

                          ShortPanicActual 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] NoteSeeChoice of Data Typesfor 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 NamesPaniek
                          118. Observation.component:Panic.value[x]:valueQuantity.value
                          Definition

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

                          ShortNumerical value (with implicit precision)
                          Comments

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

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

                          Precision is handled implicitly in almost all cases of measurement.

                          Min Value0
                          Max Value1
                          120. Observation.component:Panic.value[x]:valueQuantity.comparator
                          Definition

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

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

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

                          Control0..1
                          BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                          How the Quantity should be understood and represented.

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

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

                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                          122. Observation.component:Moaning
                          Slice NameMoaning
                          Definition

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

                          ShortComponent results
                          Comments

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

                          Control0..1*
                          TypeBackboneElement
                          Summarytrue
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          124. Observation.component:Moaning.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
                          126. Observation.component:Moaning.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|3.0.2
                          (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                              "code" : "12.17.9"
                            }]
                          }
                          128. Observation.component:Moaning.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] NoteSeeChoice of Data Typesfor 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.

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

                            Moaning, groaning; monotonous sound on plaintive tone


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

                            ShortMoaningActual 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] NoteSeeChoice of Data Typesfor 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 NamesKreunen
                            132. Observation.component:Moaning.value[x]:valueQuantity.value
                            Definition

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

                            ShortNumerical value (with implicit precision)
                            Comments

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

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

                            Precision is handled implicitly in almost all cases of measurement.

                            Min Value0
                            Max Value1
                            134. Observation.component:Moaning.value[x]:valueQuantity.comparator
                            Definition

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

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

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

                            Control0..1
                            BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                            How the Quantity should be understood and represented.

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

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

                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                            136. Observation.component:Cry
                            Slice NameCry
                            Definition

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

                            ShortComponent results
                            Comments

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

                            Control0..1*
                            TypeBackboneElement
                            Summarytrue
                            Requirements

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

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

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

                            ShortExtensions that cannot be ignored
                            Comments

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

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                            Summarytrue
                            Alternate Namesextensions, user content, modifiers
                            140. Observation.component:Cry.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|3.0.2
                            (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                            Codes identifying names of simple observations.

                            TypeCodeableConcept
                            Summarytrue
                            Requirements

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

                            Pattern Value{
                              "coding" : [{
                                "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                "code" : "12.17.10"
                              }]
                            }
                            142. Observation.component:Cry.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] NoteSeeChoice of Data Typesfor 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.

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

                              Cries softly; crying is accompanied by a shocking breath.


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

                              ShortCryActual 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] NoteSeeChoice of Data Typesfor 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 NamesHuilen
                              146. Observation.component:Cry.value[x]:valueQuantity.value
                              Definition

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

                              ShortNumerical value (with implicit precision)
                              Comments

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

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

                              Precision is handled implicitly in almost all cases of measurement.

                              Min Value0
                              Max Value1
                              148. Observation.component:Cry.value[x]:valueQuantity.comparator
                              Definition

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

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

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

                              Control0..1
                              BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                              How the Quantity should be understood and represented.

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

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

                              Meaning if MissingIf there is no comparator, then there is no modification of the value
                              150. Observation.component:SoundsOfRestlessness
                              Slice NameSoundsOfRestlessness
                              Definition

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

                              ShortComponent results
                              Comments

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

                              Control0..1*
                              TypeBackboneElement
                              Summarytrue
                              Requirements

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

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              152. Observation.component:SoundsOfRestlessness.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
                              154. Observation.component:SoundsOfRestlessness.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|3.0.2
                              (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                              Codes identifying names of simple observations.

                              TypeCodeableConcept
                              Summarytrue
                              Requirements

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

                              Pattern Value{
                                "coding" : [{
                                  "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                  "code" : "12.17.11"
                                }]
                              }
                              156. Observation.component:SoundsOfRestlessness.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] NoteSeeChoice of Data Typesfor 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.

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

                                Penetrating sounds of restlessness: sudden or longer lasting intense cries or verbal expressions of pain, such as "au" or 'you hurt me'


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

                                ShortSoundsOfRestlessnessActual 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] NoteSeeChoice of Data Typesfor 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 NamesOnrustigeGeluiden
                                160. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.value
                                Definition

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

                                ShortNumerical value (with implicit precision)
                                Comments

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

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

                                Precision is handled implicitly in almost all cases of measurement.

                                Min Value0
                                Max Value1
                                162. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.comparator
                                Definition

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

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

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

                                Control0..1
                                BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                How the Quantity should be understood and represented.

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

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

                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                164. Observation.component:Tears
                                Slice NameTears
                                Definition

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

                                ShortComponent results
                                Comments

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

                                Control0..1*
                                TypeBackboneElement
                                Summarytrue
                                Requirements

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                166. Observation.component:Tears.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:Tears.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|3.0.2
                                (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                                Codes identifying names of simple observations.

                                TypeCodeableConcept
                                Summarytrue
                                Requirements

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

                                Pattern Value{
                                  "coding" : [{
                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                    "code" : "12.17.12"
                                  }]
                                }
                                170. Observation.component:Tears.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] NoteSeeChoice of Data Typesfor 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.

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

                                  Tears: child produces tears in at least one eye, so more than just watery eyes.


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

                                  ShortTearsActual 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] NoteSeeChoice of Data Typesfor 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 NamesTranen
                                  174. Observation.component:Tears.value[x]:valueQuantity.value
                                  Definition

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

                                  ShortNumerical value (with implicit precision)
                                  Comments

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

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

                                  Precision is handled implicitly in almost all cases of measurement.

                                  Min Value0
                                  Max Value1
                                  176. Observation.component:Tears.value[x]:valueQuantity.comparator
                                  Definition

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

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

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

                                  Control0..1
                                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2
                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                  How the Quantity should be understood and represented.

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

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

                                  Meaning if MissingIf there is no comparator, then there is no modification of the value

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

                                  0. Observation
                                  Definition

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

                                  ShortChecklistPainBehaviour
                                  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, ChecklistPijnGedrag
                                  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|3.0.2)

                                  A human language.

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

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

                                  ShortText summary of the resource, for human interpretation
                                  Comments

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

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

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

                                  ShortContained, inline Resources
                                  Comments

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

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

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

                                  ShortAdditional Content defined by implementations
                                  Comments

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

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

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

                                  ShortExtensions that cannot be ignored
                                  Comments

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

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

                                  A unique identifier assigned to this observation.

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

                                  Allows observations to be distinguished and referenced.

                                  20. Observation.basedOn
                                  Definition

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

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

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

                                  Alternate NamesFulfills
                                  22. Observation.status
                                  Definition

                                  The status of the result value.

                                  Shortregistered | preliminary | final | amended +
                                  Comments

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

                                  Control1..1
                                  BindingThe codes SHALL be taken from ObservationStatus
                                  (required to http://hl7.org/fhir/ValueSet/observation-status|3.0.2)

                                  Codes providing the status of an observation.

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

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

                                  24. Observation.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|3.0.2)

                                  Codes for high level observation categories.

                                  TypeCodeableConcept
                                  Requirements

                                  Used for filtering what observations are retrieved and displayed.

                                  26. Observation.code
                                  Definition

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

                                  ShortType of observation (code / type)
                                  Control1..1
                                  BindingFor example codes, see LOINC Codes
                                  (example to http://hl7.org/fhir/ValueSet/observation-codes|3.0.2)

                                  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
                                  28. Observation.code.id
                                  Definition

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

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

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

                                  ShortAdditional Content defined by implementations
                                  Comments

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

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

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    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 areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ code
                                    • 34. Observation.code.coding:ChecklistPainBehaviourCode
                                      Slice NameChecklistPainBehaviourCode
                                      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.

                                      36. Observation.code.coding:ChecklistPainBehaviourCode.id
                                      Definition

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

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      38. Observation.code.coding:ChecklistPainBehaviourCode.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 areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 40. Observation.code.coding:ChecklistPainBehaviourCode.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
                                        42. Observation.code.coding:ChecklistPainBehaviourCode.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 version Id, not a resource version Id (see discussion)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        44. Observation.code.coding:ChecklistPainBehaviourCode.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 Value108331000146104
                                        46. Observation.code.coding:ChecklistPainBehaviourCode.display
                                        Definition

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

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

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

                                        48. Observation.code.coding:ChecklistPainBehaviourCode.userSelected
                                        Definition

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

                                        ShortIf this coding was chosen directly by the user
                                        Comments

                                        Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                        This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                        50. Observation.code.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.

                                        52. 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.

                                        54. 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
                                        56. 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.

                                        Control1..1
                                        TypedateTime
                                        [x] NoteSeeChoice of Data Typesfor 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
                                        SlicingThis element introduces a set of slices on Observation.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                        • type @ $this
                                        • 58. Observation.effective[x]:effectiveDateTime
                                          Slice NameeffectiveDateTime
                                          Definition

                                          The date and time at which the CPB score was determined.

                                          ShortScoreDateTime
                                          Comments

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

                                          Control1..1
                                          TypedateTime
                                          [x] NoteSeeChoice of Data Typesfor 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, ScoreDatumTijd
                                          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 areUnordered 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] NoteSeeChoice of Data Typesfor 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.

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

                                              The total score is the sum of all the individual scores. The total score has a range from 0 - 10.

                                              ShortTotalScore
                                              Comments

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

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

                                              Control0..1
                                              This element is affected by the following invariants: obs-7
                                              TypeQuantity
                                              [x] NoteSeeChoice of Data Typesfor 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 NamesTotaalScore
                                              Min Value{ "value" : 0 }
                                              Max Value{ "value" : 10 }
                                              80. 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|3.0.2)

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

                                              TypeCodeableConcept
                                              Requirements

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

                                              82. 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|3.0.2)

                                              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
                                              84. Observation.comment
                                              Definition

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

                                              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
                                              86. 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|3.0.2)

                                              Codes describing anatomical locations. May include laterality.

                                              TypeCodeableConcept
                                              88. 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|3.0.2)

                                              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.

                                              90. 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)
                                              92. 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)
                                              94. 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())
                                              96. 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.
                                              98. 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
                                              100. 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
                                              102. 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)
                                              104. 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)
                                              106. 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|3.0.2)

                                              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.

                                              108. 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|3.0.2)

                                              Codes identifying the population the reference range applies to.

                                              TypeCodeableConcept
                                              Requirements

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

                                              110. 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.

                                              112. 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
                                              114. 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()))
                                              116. 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.
                                              118. 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
                                              120. 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
                                              122. 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|3.0.2)

                                              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.

                                              124. 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)
                                              126. 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 areUnordered and Open, and can be differentiated using the following discriminators:
                                              • pattern @ code
                                              • 128. 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.
                                                130. 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
                                                132. 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
                                                134. 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|3.0.2)

                                                Codes identifying names of simple observations.

                                                TypeCodeableConcept
                                                Summarytrue
                                                Requirements

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

                                                136. 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] NoteSeeChoice of Data Typesfor 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.

                                                138. 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|3.0.2)

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

                                                TypeCodeableConcept
                                                Requirements

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

                                                140. 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|3.0.2)

                                                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
                                                142. 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..*
                                                TypeSeettp://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.

                                                144. Observation.component:Face
                                                Slice NameFace
                                                Definition

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

                                                ShortComponent results
                                                Comments

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

                                                Control0..1
                                                TypeBackboneElement
                                                Summarytrue
                                                Requirements

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

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

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

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

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

                                                ShortAdditional Content defined by implementations
                                                Comments

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

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

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

                                                ShortExtensions that cannot be ignored
                                                Comments

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

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                Summarytrue
                                                Alternate Namesextensions, user content, modifiers
                                                152. Observation.component:Face.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|3.0.2)

                                                Codes identifying names of simple observations.

                                                TypeCodeableConcept
                                                Summarytrue
                                                Requirements

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

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                    "code" : "12.17.3"
                                                  }]
                                                }
                                                154. Observation.component:Face.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.
                                                156. Observation.component:Face.code.extension
                                                Definition

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

                                                ShortAdditional Content defined by implementations
                                                Comments

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

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

                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

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

                                                  Control0..*
                                                  TypeCoding
                                                  Summarytrue
                                                  Requirements

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

                                                  160. Observation.component:Face.code.coding.id
                                                  Definition

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

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

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

                                                  ShortAdditional Content defined by implementations
                                                  Comments

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

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

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

                                                    ShortIdentity of the terminology system
                                                    Comments

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

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

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

                                                    166. Observation.component:Face.code.coding.version
                                                    Definition

                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                    ShortVersion of the system - if relevant
                                                    Comments

                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                    NoteThis is a business version Id, 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
                                                    168. Observation.component:Face.code.coding.code
                                                    Definition

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

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

                                                    Need to refer to a particular code in the system.

                                                    170. Observation.component:Face.code.coding.display
                                                    Definition

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

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

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

                                                    172. Observation.component:Face.code.coding.userSelected
                                                    Definition

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

                                                    ShortIf this coding was chosen directly by the user
                                                    Comments

                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                    174. Observation.component:Face.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.

                                                    176. Observation.component:Face.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] NoteSeeChoice of Data Typesfor 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.

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

                                                      Tense face; one or more muscles in the face are tensed.

                                                      ShortFace
                                                      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] NoteSeeChoice of Data Typesfor 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 NamesGezicht
                                                      180. Observation.component:Face.value[x]:valueQuantity.id
                                                      Definition

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

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

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

                                                      ShortAdditional Content defined by implementations
                                                      Comments

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

                                                      Control0..*
                                                      TypeExtension
                                                      Alternate Namesextensions, user content
                                                      SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 184. Observation.component:Face.value[x]:valueQuantity.value
                                                        Definition

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

                                                        ShortNumerical value (with implicit precision)
                                                        Comments

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

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

                                                        Precision is handled implicitly in almost all cases of measurement.

                                                        Min Value0
                                                        Max Value1
                                                        186. Observation.component:Face.value[x]:valueQuantity.comparator
                                                        Definition

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

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

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

                                                        Control0..1
                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                        How the Quantity should be understood and represented.

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

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

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

                                                        A human-readable form of the unit.

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

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

                                                        190. Observation.component:Face.value[x]:valueQuantity.system
                                                        Definition

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

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

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

                                                        192. Observation.component:Face.value[x]:valueQuantity.code
                                                        Definition

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

                                                        ShortCoded form of the unit
                                                        Comments

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

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

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

                                                        194. Observation.component:Face.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|3.0.2)

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

                                                        TypeCodeableConcept
                                                        Requirements

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

                                                        196. Observation.component:Face.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|3.0.2)

                                                        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
                                                        198. Observation.component:Face.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..*
                                                        TypeSeettp://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.

                                                        200. Observation.component:Mouth
                                                        Slice NameMouth
                                                        Definition

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

                                                        ShortComponent results
                                                        Comments

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

                                                        Control0..1
                                                        TypeBackboneElement
                                                        Summarytrue
                                                        Requirements

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

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

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

                                                        Shortxml:id (or equivalent in JSON)
                                                        Control0..1
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        204. Observation.component:Mouth.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
                                                        206. Observation.component:Mouth.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
                                                        208. Observation.component:Mouth.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|3.0.2)

                                                        Codes identifying names of simple observations.

                                                        TypeCodeableConcept
                                                        Summarytrue
                                                        Requirements

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

                                                        Pattern Value{
                                                          "coding" : [{
                                                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                            "code" : "12.17.4"
                                                          }]
                                                        }
                                                        210. Observation.component:Mouth.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.
                                                        212. Observation.component:Mouth.code.extension
                                                        Definition

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

                                                        ShortAdditional Content defined by implementations
                                                        Comments

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

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

                                                          A reference to a code defined by a terminology system.

                                                          ShortCode defined by a terminology system
                                                          Comments

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

                                                          Control0..*
                                                          TypeCoding
                                                          Summarytrue
                                                          Requirements

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

                                                          216. Observation.component:Mouth.code.coding.id
                                                          Definition

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

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

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

                                                          ShortAdditional Content defined by implementations
                                                          Comments

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

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

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

                                                            ShortIdentity of the terminology system
                                                            Comments

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

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

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

                                                            222. Observation.component:Mouth.code.coding.version
                                                            Definition

                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                            ShortVersion of the system - if relevant
                                                            Comments

                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                            NoteThis is a business version Id, 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
                                                            224. Observation.component:Mouth.code.coding.code
                                                            Definition

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

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

                                                            Need to refer to a particular code in the system.

                                                            226. Observation.component:Mouth.code.coding.display
                                                            Definition

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

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

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

                                                            228. Observation.component:Mouth.code.coding.userSelected
                                                            Definition

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

                                                            ShortIf this coding was chosen directly by the user
                                                            Comments

                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                            230. Observation.component:Mouth.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.

                                                            232. Observation.component:Mouth.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] NoteSeeChoice of Data Typesfor 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.

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

                                                              Deeper naso-labial furrow; the line between the nose and mouth (naso-labial furrow) is deeper and aside.

                                                              ShortMouth
                                                              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] NoteSeeChoice of Data Typesfor 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 NamesMond
                                                              236. Observation.component:Mouth.value[x]:valueQuantity.id
                                                              Definition

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

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

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

                                                              ShortAdditional Content defined by implementations
                                                              Comments

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

                                                              Control0..*
                                                              TypeExtension
                                                              Alternate Namesextensions, user content
                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 240. Observation.component:Mouth.value[x]:valueQuantity.value
                                                                Definition

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

                                                                ShortNumerical value (with implicit precision)
                                                                Comments

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

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

                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                Min Value0
                                                                Max Value1
                                                                242. Observation.component:Mouth.value[x]:valueQuantity.comparator
                                                                Definition

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

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

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

                                                                Control0..1
                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                How the Quantity should be understood and represented.

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

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

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

                                                                A human-readable form of the unit.

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

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

                                                                246. Observation.component:Mouth.value[x]:valueQuantity.system
                                                                Definition

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

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

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

                                                                248. Observation.component:Mouth.value[x]:valueQuantity.code
                                                                Definition

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

                                                                ShortCoded form of the unit
                                                                Comments

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

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

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

                                                                250. Observation.component:Mouth.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|3.0.2)

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

                                                                TypeCodeableConcept
                                                                Requirements

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

                                                                252. Observation.component:Mouth.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|3.0.2)

                                                                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
                                                                254. Observation.component:Mouth.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..*
                                                                TypeSeettp://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.

                                                                256. Observation.component:Grimace
                                                                Slice NameGrimace
                                                                Definition

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

                                                                ShortComponent results
                                                                Comments

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

                                                                Control0..1
                                                                TypeBackboneElement
                                                                Summarytrue
                                                                Requirements

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

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

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

                                                                Shortxml:id (or equivalent in JSON)
                                                                Control0..1
                                                                Typestring
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                260. Observation.component:Grimace.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
                                                                262. Observation.component:Grimace.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
                                                                264. Observation.component:Grimace.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|3.0.2)

                                                                Codes identifying names of simple observations.

                                                                TypeCodeableConcept
                                                                Summarytrue
                                                                Requirements

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

                                                                Pattern Value{
                                                                  "coding" : [{
                                                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                    "code" : "12.17.5"
                                                                  }]
                                                                }
                                                                266. Observation.component:Grimace.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.
                                                                268. Observation.component:Grimace.code.extension
                                                                Definition

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

                                                                ShortAdditional Content defined by implementations
                                                                Comments

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

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

                                                                  A reference to a code defined by a terminology system.

                                                                  ShortCode defined by a terminology system
                                                                  Comments

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

                                                                  Control0..*
                                                                  TypeCoding
                                                                  Summarytrue
                                                                  Requirements

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

                                                                  272. Observation.component:Grimace.code.coding.id
                                                                  Definition

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

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

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

                                                                  ShortAdditional Content defined by implementations
                                                                  Comments

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

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

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

                                                                    ShortIdentity of the terminology system
                                                                    Comments

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

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

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

                                                                    278. Observation.component:Grimace.code.coding.version
                                                                    Definition

                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                    ShortVersion of the system - if relevant
                                                                    Comments

                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                    NoteThis is a business version Id, 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
                                                                    280. Observation.component:Grimace.code.coding.code
                                                                    Definition

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

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

                                                                    Need to refer to a particular code in the system.

                                                                    282. Observation.component:Grimace.code.coding.display
                                                                    Definition

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

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

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

                                                                    284. Observation.component:Grimace.code.coding.userSelected
                                                                    Definition

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

                                                                    ShortIf this coding was chosen directly by the user
                                                                    Comments

                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                    286. Observation.component:Grimace.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.

                                                                    288. Observation.component:Grimace.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                      Grimace; the co-occurrence of: furrowed eyebrows; eyes that are composed or pinched; a deeper line between the nose and mouth; opened mouth.

                                                                      ShortGrimace
                                                                      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] NoteSeeChoice of Data Typesfor 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 NamesGrimas
                                                                      292. Observation.component:Grimace.value[x]:valueQuantity.id
                                                                      Definition

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

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

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

                                                                      ShortAdditional Content defined by implementations
                                                                      Comments

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

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Alternate Namesextensions, user content
                                                                      SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 296. Observation.component:Grimace.value[x]:valueQuantity.value
                                                                        Definition

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

                                                                        ShortNumerical value (with implicit precision)
                                                                        Comments

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

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

                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                        Min Value0
                                                                        Max Value1
                                                                        298. Observation.component:Grimace.value[x]:valueQuantity.comparator
                                                                        Definition

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

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

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

                                                                        Control0..1
                                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                        How the Quantity should be understood and represented.

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

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

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

                                                                        A human-readable form of the unit.

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

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

                                                                        302. Observation.component:Grimace.value[x]:valueQuantity.system
                                                                        Definition

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

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

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

                                                                        304. Observation.component:Grimace.value[x]:valueQuantity.code
                                                                        Definition

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

                                                                        ShortCoded form of the unit
                                                                        Comments

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

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

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

                                                                        306. Observation.component:Grimace.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|3.0.2)

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

                                                                        TypeCodeableConcept
                                                                        Requirements

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

                                                                        308. Observation.component:Grimace.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|3.0.2)

                                                                        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
                                                                        310. Observation.component:Grimace.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..*
                                                                        TypeSeettp://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.

                                                                        312. Observation.component:LookingSad
                                                                        Slice NameLookingSad
                                                                        Definition

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

                                                                        ShortComponent results
                                                                        Comments

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

                                                                        Control0..1
                                                                        TypeBackboneElement
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                        314. Observation.component:LookingSad.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.
                                                                        316. Observation.component:LookingSad.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
                                                                        318. Observation.component:LookingSad.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
                                                                        320. Observation.component:LookingSad.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|3.0.2)

                                                                        Codes identifying names of simple observations.

                                                                        TypeCodeableConcept
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Pattern Value{
                                                                          "coding" : [{
                                                                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                            "code" : "12.17.6"
                                                                          }]
                                                                        }
                                                                        322. Observation.component:LookingSad.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.
                                                                        324. Observation.component:LookingSad.code.extension
                                                                        Definition

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

                                                                        ShortAdditional Content defined by implementations
                                                                        Comments

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

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

                                                                          A reference to a code defined by a terminology system.

                                                                          ShortCode defined by a terminology system
                                                                          Comments

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

                                                                          Control0..*
                                                                          TypeCoding
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          328. Observation.component:LookingSad.code.coding.id
                                                                          Definition

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

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

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

                                                                          ShortAdditional Content defined by implementations
                                                                          Comments

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

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

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

                                                                            ShortIdentity of the terminology system
                                                                            Comments

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

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

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

                                                                            334. Observation.component:LookingSad.code.coding.version
                                                                            Definition

                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                            ShortVersion of the system - if relevant
                                                                            Comments

                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                            NoteThis is a business version Id, 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
                                                                            336. Observation.component:LookingSad.code.coding.code
                                                                            Definition

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

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

                                                                            Need to refer to a particular code in the system.

                                                                            338. Observation.component:LookingSad.code.coding.display
                                                                            Definition

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

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

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

                                                                            340. Observation.component:LookingSad.code.coding.userSelected
                                                                            Definition

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

                                                                            ShortIf this coding was chosen directly by the user
                                                                            Comments

                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                            342. Observation.component:LookingSad.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.

                                                                            344. Observation.component:LookingSad.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                              Looking sad, almost in tears: eyebrows which have been pulled up laterally on the inner sides; wrinkles in the forehead, especially over the nose; eyes are squeezed; mouth drawn down possibly combined with a pout.

                                                                              ShortLookingSad
                                                                              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] NoteSeeChoice of Data Typesfor 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 NamesVerdrietigeBlik
                                                                              348. Observation.component:LookingSad.value[x]:valueQuantity.id
                                                                              Definition

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

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

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

                                                                              ShortAdditional Content defined by implementations
                                                                              Comments

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

                                                                              Control0..*
                                                                              TypeExtension
                                                                              Alternate Namesextensions, user content
                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 352. Observation.component:LookingSad.value[x]:valueQuantity.value
                                                                                Definition

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

                                                                                ShortNumerical value (with implicit precision)
                                                                                Comments

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

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

                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                Min Value0
                                                                                Max Value1
                                                                                354. Observation.component:LookingSad.value[x]:valueQuantity.comparator
                                                                                Definition

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

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

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

                                                                                Control0..1
                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                How the Quantity should be understood and represented.

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

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

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

                                                                                A human-readable form of the unit.

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

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

                                                                                358. Observation.component:LookingSad.value[x]:valueQuantity.system
                                                                                Definition

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

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

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

                                                                                360. Observation.component:LookingSad.value[x]:valueQuantity.code
                                                                                Definition

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

                                                                                ShortCoded form of the unit
                                                                                Comments

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

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

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

                                                                                362. Observation.component:LookingSad.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|3.0.2)

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

                                                                                TypeCodeableConcept
                                                                                Requirements

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

                                                                                364. Observation.component:LookingSad.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|3.0.2)

                                                                                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
                                                                                366. Observation.component:LookingSad.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..*
                                                                                TypeSeettp://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.

                                                                                368. Observation.component:Eyes
                                                                                Slice NameEyes
                                                                                Definition

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

                                                                                ShortComponent results
                                                                                Comments

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

                                                                                Control0..1
                                                                                TypeBackboneElement
                                                                                Summarytrue
                                                                                Requirements

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

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                370. Observation.component:Eyes.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.
                                                                                372. Observation.component:Eyes.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
                                                                                374. Observation.component:Eyes.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
                                                                                376. Observation.component:Eyes.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|3.0.2)

                                                                                Codes identifying names of simple observations.

                                                                                TypeCodeableConcept
                                                                                Summarytrue
                                                                                Requirements

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

                                                                                Pattern Value{
                                                                                  "coding" : [{
                                                                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                    "code" : "12.17.7"
                                                                                  }]
                                                                                }
                                                                                378. Observation.component:Eyes.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.
                                                                                380. Observation.component:Eyes.code.extension
                                                                                Definition

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

                                                                                ShortAdditional Content defined by implementations
                                                                                Comments

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

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

                                                                                  A reference to a code defined by a terminology system.

                                                                                  ShortCode defined by a terminology system
                                                                                  Comments

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

                                                                                  Control0..*
                                                                                  TypeCoding
                                                                                  Summarytrue
                                                                                  Requirements

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

                                                                                  384. Observation.component:Eyes.code.coding.id
                                                                                  Definition

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

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

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

                                                                                  ShortAdditional Content defined by implementations
                                                                                  Comments

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

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

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

                                                                                    ShortIdentity of the terminology system
                                                                                    Comments

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

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

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

                                                                                    390. Observation.component:Eyes.code.coding.version
                                                                                    Definition

                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                    ShortVersion of the system - if relevant
                                                                                    Comments

                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                    NoteThis is a business version Id, 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
                                                                                    392. Observation.component:Eyes.code.coding.code
                                                                                    Definition

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

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

                                                                                    Need to refer to a particular code in the system.

                                                                                    394. Observation.component:Eyes.code.coding.display
                                                                                    Definition

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

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

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

                                                                                    396. Observation.component:Eyes.code.coding.userSelected
                                                                                    Definition

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

                                                                                    ShortIf this coding was chosen directly by the user
                                                                                    Comments

                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                    398. Observation.component:Eyes.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.

                                                                                    400. Observation.component:Eyes.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                      Eyes squeezed. Note: Do NOT score as present when the child is blinking or when the eyes are still closed without blinking.

                                                                                      ShortEyes
                                                                                      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] NoteSeeChoice of Data Typesfor 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 NamesOgen
                                                                                      404. Observation.component:Eyes.value[x]:valueQuantity.id
                                                                                      Definition

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

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

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

                                                                                      ShortAdditional Content defined by implementations
                                                                                      Comments

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

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Alternate Namesextensions, user content
                                                                                      SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 408. Observation.component:Eyes.value[x]:valueQuantity.value
                                                                                        Definition

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

                                                                                        ShortNumerical value (with implicit precision)
                                                                                        Comments

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

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

                                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                                        Min Value0
                                                                                        Max Value1
                                                                                        410. Observation.component:Eyes.value[x]:valueQuantity.comparator
                                                                                        Definition

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

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

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

                                                                                        Control0..1
                                                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                        How the Quantity should be understood and represented.

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

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

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

                                                                                        A human-readable form of the unit.

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

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

                                                                                        414. Observation.component:Eyes.value[x]:valueQuantity.system
                                                                                        Definition

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

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

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

                                                                                        416. Observation.component:Eyes.value[x]:valueQuantity.code
                                                                                        Definition

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

                                                                                        ShortCoded form of the unit
                                                                                        Comments

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

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

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

                                                                                        418. Observation.component:Eyes.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|3.0.2)

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

                                                                                        TypeCodeableConcept
                                                                                        Requirements

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

                                                                                        420. Observation.component:Eyes.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|3.0.2)

                                                                                        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
                                                                                        422. Observation.component:Eyes.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..*
                                                                                        TypeSeettp://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.

                                                                                        424. Observation.component:Panic
                                                                                        Slice NamePanic
                                                                                        Definition

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

                                                                                        ShortComponent results
                                                                                        Comments

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

                                                                                        Control0..1
                                                                                        TypeBackboneElement
                                                                                        Summarytrue
                                                                                        Requirements

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

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                        426. Observation.component:Panic.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.
                                                                                        428. Observation.component:Panic.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
                                                                                        430. Observation.component:Panic.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
                                                                                        432. Observation.component:Panic.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|3.0.2)

                                                                                        Codes identifying names of simple observations.

                                                                                        TypeCodeableConcept
                                                                                        Summarytrue
                                                                                        Requirements

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

                                                                                        Pattern Value{
                                                                                          "coding" : [{
                                                                                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                            "code" : "12.17.8"
                                                                                          }]
                                                                                        }
                                                                                        434. Observation.component:Panic.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.
                                                                                        436. Observation.component:Panic.code.extension
                                                                                        Definition

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

                                                                                        ShortAdditional Content defined by implementations
                                                                                        Comments

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

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

                                                                                          A reference to a code defined by a terminology system.

                                                                                          ShortCode defined by a terminology system
                                                                                          Comments

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

                                                                                          Control0..*
                                                                                          TypeCoding
                                                                                          Summarytrue
                                                                                          Requirements

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

                                                                                          440. Observation.component:Panic.code.coding.id
                                                                                          Definition

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

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

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

                                                                                          ShortAdditional Content defined by implementations
                                                                                          Comments

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

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

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

                                                                                            ShortIdentity of the terminology system
                                                                                            Comments

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

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

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

                                                                                            446. Observation.component:Panic.code.coding.version
                                                                                            Definition

                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                            ShortVersion of the system - if relevant
                                                                                            Comments

                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                            NoteThis is a business version Id, 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
                                                                                            448. Observation.component:Panic.code.coding.code
                                                                                            Definition

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

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

                                                                                            Need to refer to a particular code in the system.

                                                                                            450. Observation.component:Panic.code.coding.display
                                                                                            Definition

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

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

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

                                                                                            452. Observation.component:Panic.code.coding.userSelected
                                                                                            Definition

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

                                                                                            ShortIf this coding was chosen directly by the user
                                                                                            Comments

                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                            454. Observation.component:Panic.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.

                                                                                            456. Observation.component:Panic.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                              Panics, panic attack: an extreme form of anxiety which manifests itself in random restless body movements or violent resistance. This may be associated with an anxious look characterized by large widely opened eyes and eyebrows which are on the inner side raised up.

                                                                                              ShortPanic
                                                                                              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] NoteSeeChoice of Data Typesfor 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 NamesPaniek
                                                                                              460. Observation.component:Panic.value[x]:valueQuantity.id
                                                                                              Definition

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

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

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

                                                                                              ShortAdditional Content defined by implementations
                                                                                              Comments

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

                                                                                              Control0..*
                                                                                              TypeExtension
                                                                                              Alternate Namesextensions, user content
                                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                              • value @ url
                                                                                              • 464. Observation.component:Panic.value[x]:valueQuantity.value
                                                                                                Definition

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

                                                                                                ShortNumerical value (with implicit precision)
                                                                                                Comments

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

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

                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                Min Value0
                                                                                                Max Value1
                                                                                                466. Observation.component:Panic.value[x]:valueQuantity.comparator
                                                                                                Definition

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

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

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

                                                                                                Control0..1
                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                                How the Quantity should be understood and represented.

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

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

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

                                                                                                A human-readable form of the unit.

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

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

                                                                                                470. Observation.component:Panic.value[x]:valueQuantity.system
                                                                                                Definition

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

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

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

                                                                                                472. Observation.component:Panic.value[x]:valueQuantity.code
                                                                                                Definition

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

                                                                                                ShortCoded form of the unit
                                                                                                Comments

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

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

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

                                                                                                474. Observation.component:Panic.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|3.0.2)

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

                                                                                                TypeCodeableConcept
                                                                                                Requirements

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

                                                                                                476. Observation.component:Panic.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|3.0.2)

                                                                                                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
                                                                                                478. Observation.component:Panic.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..*
                                                                                                TypeSeettp://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.

                                                                                                480. Observation.component:Moaning
                                                                                                Slice NameMoaning
                                                                                                Definition

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

                                                                                                ShortComponent results
                                                                                                Comments

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

                                                                                                Control0..1
                                                                                                TypeBackboneElement
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                                482. Observation.component:Moaning.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.
                                                                                                484. Observation.component:Moaning.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
                                                                                                486. Observation.component:Moaning.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
                                                                                                488. Observation.component:Moaning.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|3.0.2)

                                                                                                Codes identifying names of simple observations.

                                                                                                TypeCodeableConcept
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Pattern Value{
                                                                                                  "coding" : [{
                                                                                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                                    "code" : "12.17.9"
                                                                                                  }]
                                                                                                }
                                                                                                490. Observation.component:Moaning.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.
                                                                                                492. Observation.component:Moaning.code.extension
                                                                                                Definition

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

                                                                                                ShortAdditional Content defined by implementations
                                                                                                Comments

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

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

                                                                                                  A reference to a code defined by a terminology system.

                                                                                                  ShortCode defined by a terminology system
                                                                                                  Comments

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

                                                                                                  Control0..*
                                                                                                  TypeCoding
                                                                                                  Summarytrue
                                                                                                  Requirements

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

                                                                                                  496. Observation.component:Moaning.code.coding.id
                                                                                                  Definition

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

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

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

                                                                                                  ShortAdditional Content defined by implementations
                                                                                                  Comments

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

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

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

                                                                                                    ShortIdentity of the terminology system
                                                                                                    Comments

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

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

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

                                                                                                    502. Observation.component:Moaning.code.coding.version
                                                                                                    Definition

                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                    ShortVersion of the system - if relevant
                                                                                                    Comments

                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                    NoteThis is a business version Id, 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
                                                                                                    504. Observation.component:Moaning.code.coding.code
                                                                                                    Definition

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

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

                                                                                                    Need to refer to a particular code in the system.

                                                                                                    506. Observation.component:Moaning.code.coding.display
                                                                                                    Definition

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

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

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

                                                                                                    508. Observation.component:Moaning.code.coding.userSelected
                                                                                                    Definition

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

                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                    Comments

                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                    510. Observation.component:Moaning.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.

                                                                                                    512. Observation.component:Moaning.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                                      Moaning, groaning; monotonous sound on plaintive tone

                                                                                                      ShortMoaning
                                                                                                      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] NoteSeeChoice of Data Typesfor 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 NamesKreunen
                                                                                                      516. Observation.component:Moaning.value[x]:valueQuantity.id
                                                                                                      Definition

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

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

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

                                                                                                      ShortAdditional Content defined by implementations
                                                                                                      Comments

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

                                                                                                      Control0..*
                                                                                                      TypeExtension
                                                                                                      Alternate Namesextensions, user content
                                                                                                      SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                      • value @ url
                                                                                                      • 520. Observation.component:Moaning.value[x]:valueQuantity.value
                                                                                                        Definition

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

                                                                                                        ShortNumerical value (with implicit precision)
                                                                                                        Comments

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

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

                                                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                                                        Min Value0
                                                                                                        Max Value1
                                                                                                        522. Observation.component:Moaning.value[x]:valueQuantity.comparator
                                                                                                        Definition

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

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

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

                                                                                                        Control0..1
                                                                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                                        How the Quantity should be understood and represented.

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

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

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

                                                                                                        A human-readable form of the unit.

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

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

                                                                                                        526. Observation.component:Moaning.value[x]:valueQuantity.system
                                                                                                        Definition

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

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

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

                                                                                                        528. Observation.component:Moaning.value[x]:valueQuantity.code
                                                                                                        Definition

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

                                                                                                        ShortCoded form of the unit
                                                                                                        Comments

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

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

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

                                                                                                        530. Observation.component:Moaning.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|3.0.2)

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

                                                                                                        TypeCodeableConcept
                                                                                                        Requirements

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

                                                                                                        532. Observation.component:Moaning.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|3.0.2)

                                                                                                        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
                                                                                                        534. Observation.component:Moaning.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..*
                                                                                                        TypeSeettp://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.

                                                                                                        536. Observation.component:Cry
                                                                                                        Slice NameCry
                                                                                                        Definition

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

                                                                                                        ShortComponent results
                                                                                                        Comments

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

                                                                                                        Control0..1
                                                                                                        TypeBackboneElement
                                                                                                        Summarytrue
                                                                                                        Requirements

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

                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                                        538. Observation.component:Cry.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.
                                                                                                        540. Observation.component:Cry.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
                                                                                                        542. Observation.component:Cry.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
                                                                                                        544. Observation.component:Cry.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|3.0.2)

                                                                                                        Codes identifying names of simple observations.

                                                                                                        TypeCodeableConcept
                                                                                                        Summarytrue
                                                                                                        Requirements

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

                                                                                                        Pattern Value{
                                                                                                          "coding" : [{
                                                                                                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                                            "code" : "12.17.10"
                                                                                                          }]
                                                                                                        }
                                                                                                        546. Observation.component:Cry.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.
                                                                                                        548. Observation.component:Cry.code.extension
                                                                                                        Definition

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

                                                                                                        ShortAdditional Content defined by implementations
                                                                                                        Comments

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

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

                                                                                                          A reference to a code defined by a terminology system.

                                                                                                          ShortCode defined by a terminology system
                                                                                                          Comments

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

                                                                                                          Control0..*
                                                                                                          TypeCoding
                                                                                                          Summarytrue
                                                                                                          Requirements

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

                                                                                                          552. Observation.component:Cry.code.coding.id
                                                                                                          Definition

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

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

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

                                                                                                          ShortAdditional Content defined by implementations
                                                                                                          Comments

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

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

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

                                                                                                            ShortIdentity of the terminology system
                                                                                                            Comments

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

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

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

                                                                                                            558. Observation.component:Cry.code.coding.version
                                                                                                            Definition

                                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                            ShortVersion of the system - if relevant
                                                                                                            Comments

                                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                            NoteThis is a business version Id, 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
                                                                                                            560. Observation.component:Cry.code.coding.code
                                                                                                            Definition

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

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

                                                                                                            Need to refer to a particular code in the system.

                                                                                                            562. Observation.component:Cry.code.coding.display
                                                                                                            Definition

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

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

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

                                                                                                            564. Observation.component:Cry.code.coding.userSelected
                                                                                                            Definition

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

                                                                                                            ShortIf this coding was chosen directly by the user
                                                                                                            Comments

                                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                            566. Observation.component:Cry.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.

                                                                                                            568. Observation.component:Cry.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                                              Cries softly; crying is accompanied by a shocking breath.

                                                                                                              ShortCry
                                                                                                              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] NoteSeeChoice of Data Typesfor 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 NamesHuilen
                                                                                                              572. Observation.component:Cry.value[x]:valueQuantity.id
                                                                                                              Definition

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

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

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

                                                                                                              ShortAdditional Content defined by implementations
                                                                                                              Comments

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

                                                                                                              Control0..*
                                                                                                              TypeExtension
                                                                                                              Alternate Namesextensions, user content
                                                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                              • value @ url
                                                                                                              • 576. Observation.component:Cry.value[x]:valueQuantity.value
                                                                                                                Definition

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

                                                                                                                ShortNumerical value (with implicit precision)
                                                                                                                Comments

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

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

                                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                                Min Value0
                                                                                                                Max Value1
                                                                                                                578. Observation.component:Cry.value[x]:valueQuantity.comparator
                                                                                                                Definition

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

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

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

                                                                                                                Control0..1
                                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                                                How the Quantity should be understood and represented.

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

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

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

                                                                                                                A human-readable form of the unit.

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

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

                                                                                                                582. Observation.component:Cry.value[x]:valueQuantity.system
                                                                                                                Definition

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

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

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

                                                                                                                584. Observation.component:Cry.value[x]:valueQuantity.code
                                                                                                                Definition

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

                                                                                                                ShortCoded form of the unit
                                                                                                                Comments

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

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

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

                                                                                                                586. Observation.component:Cry.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|3.0.2)

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

                                                                                                                TypeCodeableConcept
                                                                                                                Requirements

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

                                                                                                                588. Observation.component:Cry.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|3.0.2)

                                                                                                                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
                                                                                                                590. Observation.component:Cry.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..*
                                                                                                                TypeSeettp://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.

                                                                                                                592. Observation.component:SoundsOfRestlessness
                                                                                                                Slice NameSoundsOfRestlessness
                                                                                                                Definition

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

                                                                                                                ShortComponent results
                                                                                                                Comments

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

                                                                                                                Control0..1
                                                                                                                TypeBackboneElement
                                                                                                                Summarytrue
                                                                                                                Requirements

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

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                                                594. Observation.component:SoundsOfRestlessness.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.
                                                                                                                596. Observation.component:SoundsOfRestlessness.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
                                                                                                                598. Observation.component:SoundsOfRestlessness.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
                                                                                                                600. Observation.component:SoundsOfRestlessness.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|3.0.2)

                                                                                                                Codes identifying names of simple observations.

                                                                                                                TypeCodeableConcept
                                                                                                                Summarytrue
                                                                                                                Requirements

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

                                                                                                                Pattern Value{
                                                                                                                  "coding" : [{
                                                                                                                    "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                                                    "code" : "12.17.11"
                                                                                                                  }]
                                                                                                                }
                                                                                                                602. Observation.component:SoundsOfRestlessness.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.
                                                                                                                604. Observation.component:SoundsOfRestlessness.code.extension
                                                                                                                Definition

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

                                                                                                                ShortAdditional Content defined by implementations
                                                                                                                Comments

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

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

                                                                                                                  A reference to a code defined by a terminology system.

                                                                                                                  ShortCode defined by a terminology system
                                                                                                                  Comments

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

                                                                                                                  Control0..*
                                                                                                                  TypeCoding
                                                                                                                  Summarytrue
                                                                                                                  Requirements

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

                                                                                                                  608. Observation.component:SoundsOfRestlessness.code.coding.id
                                                                                                                  Definition

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

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

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

                                                                                                                  ShortAdditional Content defined by implementations
                                                                                                                  Comments

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

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

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

                                                                                                                    ShortIdentity of the terminology system
                                                                                                                    Comments

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

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

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

                                                                                                                    614. Observation.component:SoundsOfRestlessness.code.coding.version
                                                                                                                    Definition

                                                                                                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                    ShortVersion of the system - if relevant
                                                                                                                    Comments

                                                                                                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                    NoteThis is a business version Id, 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
                                                                                                                    616. Observation.component:SoundsOfRestlessness.code.coding.code
                                                                                                                    Definition

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

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

                                                                                                                    Need to refer to a particular code in the system.

                                                                                                                    618. Observation.component:SoundsOfRestlessness.code.coding.display
                                                                                                                    Definition

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

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

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

                                                                                                                    620. Observation.component:SoundsOfRestlessness.code.coding.userSelected
                                                                                                                    Definition

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

                                                                                                                    ShortIf this coding was chosen directly by the user
                                                                                                                    Comments

                                                                                                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                    622. Observation.component:SoundsOfRestlessness.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.

                                                                                                                    624. Observation.component:SoundsOfRestlessness.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                                                      Penetrating sounds of restlessness: sudden or longer lasting intense cries or verbal expressions of pain, such as "au" or 'you hurt me'

                                                                                                                      ShortSoundsOfRestlessness
                                                                                                                      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] NoteSeeChoice of Data Typesfor 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 NamesOnrustigeGeluiden
                                                                                                                      628. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.id
                                                                                                                      Definition

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

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

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

                                                                                                                      ShortAdditional Content defined by implementations
                                                                                                                      Comments

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

                                                                                                                      Control0..*
                                                                                                                      TypeExtension
                                                                                                                      Alternate Namesextensions, user content
                                                                                                                      SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                      • value @ url
                                                                                                                      • 632. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.value
                                                                                                                        Definition

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

                                                                                                                        ShortNumerical value (with implicit precision)
                                                                                                                        Comments

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

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

                                                                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                                                                        Min Value0
                                                                                                                        Max Value1
                                                                                                                        634. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.comparator
                                                                                                                        Definition

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

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

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

                                                                                                                        Control0..1
                                                                                                                        BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                                                        How the Quantity should be understood and represented.

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

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

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

                                                                                                                        A human-readable form of the unit.

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

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

                                                                                                                        638. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.system
                                                                                                                        Definition

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

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

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

                                                                                                                        640. Observation.component:SoundsOfRestlessness.value[x]:valueQuantity.code
                                                                                                                        Definition

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

                                                                                                                        ShortCoded form of the unit
                                                                                                                        Comments

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

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

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

                                                                                                                        642. Observation.component:SoundsOfRestlessness.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|3.0.2)

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

                                                                                                                        TypeCodeableConcept
                                                                                                                        Requirements

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

                                                                                                                        644. Observation.component:SoundsOfRestlessness.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|3.0.2)

                                                                                                                        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
                                                                                                                        646. Observation.component:SoundsOfRestlessness.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..*
                                                                                                                        TypeSeettp://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.

                                                                                                                        648. Observation.component:Tears
                                                                                                                        Slice NameTears
                                                                                                                        Definition

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

                                                                                                                        ShortComponent results
                                                                                                                        Comments

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

                                                                                                                        Control0..1
                                                                                                                        TypeBackboneElement
                                                                                                                        Summarytrue
                                                                                                                        Requirements

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

                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                                                        650. Observation.component:Tears.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.
                                                                                                                        652. Observation.component:Tears.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
                                                                                                                        654. Observation.component:Tears.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
                                                                                                                        656. Observation.component:Tears.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|3.0.2)

                                                                                                                        Codes identifying names of simple observations.

                                                                                                                        TypeCodeableConcept
                                                                                                                        Summarytrue
                                                                                                                        Requirements

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

                                                                                                                        Pattern Value{
                                                                                                                          "coding" : [{
                                                                                                                            "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
                                                                                                                            "code" : "12.17.12"
                                                                                                                          }]
                                                                                                                        }
                                                                                                                        658. Observation.component:Tears.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.
                                                                                                                        660. Observation.component:Tears.code.extension
                                                                                                                        Definition

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

                                                                                                                        ShortAdditional Content defined by implementations
                                                                                                                        Comments

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

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

                                                                                                                          A reference to a code defined by a terminology system.

                                                                                                                          ShortCode defined by a terminology system
                                                                                                                          Comments

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

                                                                                                                          Control0..*
                                                                                                                          TypeCoding
                                                                                                                          Summarytrue
                                                                                                                          Requirements

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

                                                                                                                          664. Observation.component:Tears.code.coding.id
                                                                                                                          Definition

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

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

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

                                                                                                                          ShortAdditional Content defined by implementations
                                                                                                                          Comments

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

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

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

                                                                                                                            ShortIdentity of the terminology system
                                                                                                                            Comments

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

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

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

                                                                                                                            670. Observation.component:Tears.code.coding.version
                                                                                                                            Definition

                                                                                                                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                                                            ShortVersion of the system - if relevant
                                                                                                                            Comments

                                                                                                                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                                                            NoteThis is a business version Id, 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
                                                                                                                            672. Observation.component:Tears.code.coding.code
                                                                                                                            Definition

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

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

                                                                                                                            Need to refer to a particular code in the system.

                                                                                                                            674. Observation.component:Tears.code.coding.display
                                                                                                                            Definition

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

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

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

                                                                                                                            676. Observation.component:Tears.code.coding.userSelected
                                                                                                                            Definition

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

                                                                                                                            ShortIf this coding was chosen directly by the user
                                                                                                                            Comments

                                                                                                                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                                                                                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                                                            678. Observation.component:Tears.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.

                                                                                                                            680. Observation.component:Tears.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] NoteSeeChoice of Data Typesfor 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.

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

                                                                                                                              Tears: child produces tears in at least one eye, so more than just watery eyes.

                                                                                                                              ShortTears
                                                                                                                              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] NoteSeeChoice of Data Typesfor 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 NamesTranen
                                                                                                                              684. Observation.component:Tears.value[x]:valueQuantity.id
                                                                                                                              Definition

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

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

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

                                                                                                                              ShortAdditional Content defined by implementations
                                                                                                                              Comments

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

                                                                                                                              Control0..*
                                                                                                                              TypeExtension
                                                                                                                              Alternate Namesextensions, user content
                                                                                                                              SlicingThis element introduces a set of slices on Observation.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                              • value @ url
                                                                                                                              • 688. Observation.component:Tears.value[x]:valueQuantity.value
                                                                                                                                Definition

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

                                                                                                                                ShortNumerical value (with implicit precision)
                                                                                                                                Comments

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

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

                                                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                                                Min Value0
                                                                                                                                Max Value1
                                                                                                                                690. Observation.component:Tears.value[x]:valueQuantity.comparator
                                                                                                                                Definition

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

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

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

                                                                                                                                Control0..1
                                                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|3.0.2)

                                                                                                                                How the Quantity should be understood and represented.

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

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

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

                                                                                                                                A human-readable form of the unit.

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

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

                                                                                                                                694. Observation.component:Tears.value[x]:valueQuantity.system
                                                                                                                                Definition

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

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

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

                                                                                                                                696. Observation.component:Tears.value[x]:valueQuantity.code
                                                                                                                                Definition

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

                                                                                                                                ShortCoded form of the unit
                                                                                                                                Comments

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

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

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

                                                                                                                                698. Observation.component:Tears.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|3.0.2)

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

                                                                                                                                TypeCodeableConcept
                                                                                                                                Requirements

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

                                                                                                                                700. Observation.component:Tears.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|3.0.2)

                                                                                                                                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
                                                                                                                                702. Observation.component:Tears.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..*
                                                                                                                                TypeSeettp://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.