Nictiz FHIR NL STU3 Zib2017
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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 FunctionalOrMentalStatus - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-FunctionalOrMentalStatus resource profile.

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

0. Observation
ShortFunctionalOrMentalStatus
Alternate NamesFunctioneleOfMentaleStatus
2. Observation.extension
SlicingThis element introduces a set of slices on Observation.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Observation.extension:MedicalDevice
    Slice NameMedicalDevice
    Definition

    Medical aid the patient has to reduce the impact of the disability or disorder.

    ShortMedicalDevice
    TypeExtension(HCIM FunctionalOrMentalStatus MedicalDevice) (Extension Type: Reference)
    Alternate NamesHulpmiddel
    6. Observation.category
    Comments

    Either a snomed code for functional or mental status is provided for indexing and retrieval of this this concept.

    Control1..?
    8. Observation.category.coding
    SlicingThis element introduces a set of slices on Observation.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • 10. Observation.category.coding:functionalCode
      Slice NamefunctionalCode
      Definition

      Category snomed code used for indexing/retrieval of observerd functional status.

      ShortFunctional Finding
      Control0..1
      12. Observation.category.coding:functionalCode.system
      Fixed Valuehttp://snomed.info/sct
      14. Observation.category.coding:functionalCode.code
      Fixed Value118228005
      16. Observation.category.coding:functionalCode.display
      Default ValueFunctional finding (finding)
      18. Observation.category.coding:mentalCode
      Slice NamementalCode
      Definition

      Category snomed code used for indexing/retrieval of observerd mental status.

      ShortMental state, behavior and/or psychosocial function finding
      Control0..1
      20. Observation.category.coding:mentalCode.system
      Fixed Valuehttp://snomed.info/sct
      22. Observation.category.coding:mentalCode.code
      Fixed Value384821006
      24. Observation.category.coding:mentalCode.display
      Default ValueMental state, behavior and/or psychosocial function finding (finding)
      26. Observation.code
      Definition

      Coded description of the functional or mental status or limitation.

      Code systems used include: SNOMED CT ICF (International Classification of Functioning, Disability and Health) NOC (Nursing Outcomes Classification) OMAHA

      ShortStatusName
      Alternate NamesStatusNaam
      28. Observation.code.coding
      SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 30. Observation.code.coding:statusNaamOMAHACodelijst
        Slice NamestatusNaamOMAHACodelijst
        Control0..1
        BindingThe codes SHALL be taken from StatusNaamOMAHACodelijst
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.1--20171231000000)

        OMAHA (2.16.840.1.113883.6.98): All values

        32. Observation.code.coding:statusNaamNOCCodelijst
        Slice NamestatusNaamNOCCodelijst
        Control0..1
        BindingThe codes SHALL be taken from StatusNaamNOCCodelijst
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.2--20171231000000)

        NOC (2.16.840.1.113883.6.16): All values

        34. Observation.code.coding:statusNaamICFCodelijst
        Slice NamestatusNaamICFCodelijst
        Control0..1
        BindingThe codes SHALL be taken from StatusNaamICFCodelijst
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.3--20171231000000)

        ICF (2.16.840.1.113883.6.254): All values

        36. Observation.code.coding:statusNaamSnomedCodelijst
        Slice NamestatusNaamSnomedCodelijst
        Control0..1
        BindingThe codes SHALL be taken from StatusNaamSnomedCodelijst
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.4--20171231000000)

        SNOMED CT (2.16.840.1.113883.6.96): All values

        38. Observation.subject
        ShortPatient
        Alternate NamesPatiënt
        40. Observation.effectivePeriod:effectivePeriod
        Slice NameeffectivePeriod
        Comments

        ZIB FuncntioneleOfMentaleStatus does not include an end StatusDate. The effectivePeriod.start can be used as StatusDate. This profile allows to use an end date as well.

        TypePeriod
        42. Observation.effectivePeriod:effectivePeriod.start
        Definition

        Date on which the status was determined. A ‘vague’ date, such as only the year, is permitted.

        ShortStatusDate
        Alternate NamesStatusDatum
        44. Observation.valueCodeableConcept:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        The extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical aid, the evaluation of the extent of the limitation will take place without this aid.

        ShortStatusValue
        TypeCodeableConcept
        Alternate NamesStatusWaarde
        46. Observation.valueCodeableConcept:valueCodeableConcept.coding
        SlicingThis element introduces a set of slices on Observation.valueCodeableConcept.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 48. Observation.valueCodeableConcept:valueCodeableConcept.coding:statusWaardeOMAHACodelijst
          Slice NamestatusWaardeOMAHACodelijst
          Control0..1
          BindingThe codes SHALL be taken from StatusWaardeOMAHACodelijst
          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.5--20171231000000)

          OMAHA (2.16.840.1.113883.6.98): All values

          50. Observation.valueCodeableConcept:valueCodeableConcept.coding:statusWaardeNOCCodelijst
          Slice NamestatusWaardeNOCCodelijst
          Control0..1
          BindingThe codes SHALL be taken from StatusWaardeNOCCodelijst
          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.7--20171231000000)

          NOC (2.16.840.1.113883.6.16): All values

          52. Observation.valueCodeableConcept:valueCodeableConcept.coding:statusWaardeICFCodelijst
          Slice NamestatusWaardeICFCodelijst
          Control0..1
          BindingThe codes SHALL be taken from StatusWaardeICFCodelijst
          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.6--20171231000000)

          ICF (2.16.840.1.113883.6.254): All values

          54. Observation.valueCodeableConcept:valueCodeableConcept.coding:statusWaardeSnomedCodelijst
          Slice NamestatusWaardeSnomedCodelijst
          Control0..1
          BindingThe codes SHALL be taken from StatusWaardeSnomedCodelijst
          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.8--20171231000000)

          SNOMED CT (2.16.840.1.113883.6.96): All values

          56. Observation.comment
          Definition

          Explanatory comments as a description of the functional or mental status.

          ShortComment
          Alternate NamesToelichting

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

          0. Observation
          Definition

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

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

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

          ShortA set of rules under which this content was created
          Comments

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

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

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

          An Extension


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

          ShortExtensionAdditional Content defined by implementations
          Comments

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

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

            Medical aid the patient has to reduce the impact of the disability or disorder.

            ShortMedicalDevice
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(HCIM FunctionalOrMentalStatus MedicalDevice) (Extension Type: Reference)
            Alternate NamesHulpmiddel
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            8. Observation.modifierExtension
            Definition

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

            ShortExtensions that cannot be ignored
            Comments

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

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

            The status of the result value.

            Shortregistered | preliminary | final | amended +
            Comments

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

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

            Codes providing the status of an observation.

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

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

            12. Observation.category
            Definition

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

            ShortClassification of type of observation
            Comments

            Either a snomed code for functional or mental status is provided for indexing and retrieval of this this concept.


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

            Control10..*
            BindingThe codes SHOULD be taken from Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category
            (preferred to http://hl7.org/fhir/ValueSet/observation-category)

            Codes for high level observation categories.

            TypeCodeableConcept
            Requirements

            Used for filtering what observations are retrieved and displayed.

            14. Observation.category.coding
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

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

            Control0..*
            TypeCoding
            Summarytrue
            Requirements

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

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

              Category snomed code used for indexing/retrieval of observerd functional status.


              A reference to a code defined by a terminology system.

              ShortFunctional FindingCode defined by a terminology system
              Comments

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

              Control0..1*
              TypeCoding
              Summarytrue
              Requirements

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

              18. Observation.category.coding:functionalCode.system
              Definition

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

              ShortIdentity of the terminology system
              Comments

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

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

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

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

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

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

              Need to refer to a particular code in the system.

              Fixed Value118228005
              22. Observation.category.coding:functionalCode.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.

              24. Observation.category.coding:mentalCode
              Slice NamementalCode
              Definition

              Category snomed code used for indexing/retrieval of observerd mental status.


              A reference to a code defined by a terminology system.

              ShortMental state, behavior and/or psychosocial function findingCode defined by a terminology system
              Comments

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

              Control0..1*
              TypeCoding
              Summarytrue
              Requirements

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

              26. Observation.category.coding:mentalCode.system
              Definition

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

              ShortIdentity of the terminology system
              Comments

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

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

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

              Fixed Valuehttp://snomed.info/sct
              28. Observation.category.coding:mentalCode.code
              Definition

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

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

              Need to refer to a particular code in the system.

              Fixed Value384821006
              30. Observation.category.coding:mentalCode.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.

              32. Observation.code
              Definition

              Coded description of the functional or mental status or limitation.

              Code systems used include: SNOMED CT ICF (International Classification of Functioning, Disability and Health) NOC (Nursing Outcomes Classification) OMAHA


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

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Alternate NamesName, StatusNaam
              34. Observation.code.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

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

              Control0..*
              TypeCoding
              Summarytrue
              Requirements

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

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

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..1*
                BindingThe codes SHALL be taken from For codes, see StatusNaamOMAHACodelijst
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.1--20171231000000)

                OMAHA (2.16.840.1.113883.6.98): All values

                TypeCoding
                Summarytrue
                Requirements

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

                38. Observation.code.coding:statusNaamNOCCodelijst
                Slice NamestatusNaamNOCCodelijst
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..1*
                BindingThe codes SHALL be taken from For codes, see StatusNaamNOCCodelijst
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.2--20171231000000)

                NOC (2.16.840.1.113883.6.16): All values

                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.

                40. Observation.code.coding:statusNaamICFCodelijst
                Slice NamestatusNaamICFCodelijst
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..1*
                BindingThe codes SHALL be taken from For codes, see StatusNaamICFCodelijst
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.3--20171231000000)

                ICF (2.16.840.1.113883.6.254): All values

                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.

                42. Observation.code.coding:statusNaamSnomedCodelijst
                Slice NamestatusNaamSnomedCodelijst
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..1*
                BindingThe codes SHALL be taken from For codes, see StatusNaamSnomedCodelijst
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.4--20171231000000)

                SNOMED CT (2.16.840.1.113883.6.96): All values

                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.

                44. Observation.subject
                Definition

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

                ShortPatientWho and/or what this is about
                Comments

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

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

                Control10..1
                TypeReference(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.

                Alternate NamesPatiënt
                46. Observation.effective[x]
                Definition

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

                ShortClinically relevant time/time-period for observation
                Comments

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

                Control0..1
                TypePeriod, dateTime
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                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 are unordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 48. Observation.effective[x]:effectivePeriod
                  Slice NameeffectivePeriod
                  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

                  ZIB FuncntioneleOfMentaleStatus does not include an end StatusDate. The effectivePeriod.start can be used as StatusDate. This profile allows to use an end date as well.


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

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

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

                  Alternate NamesOccurrence
                  50. Observation.value[x]
                  Definition

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

                  ShortActual result
                  Comments

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

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

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Summarytrue
                  Requirements

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

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

                    The extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical aid, the evaluation of the extent of the limitation will take place without this aid.


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

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

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

                    Alternate NamesStatusWaarde
                    54. Observation.value[x]:valueCodeableConcept.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

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

                    Control0..*
                    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.value[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ system
                    • 56. Observation.value[x]:valueCodeableConcept.coding:statusWaardeOMAHACodelijst
                      Slice NamestatusWaardeOMAHACodelijst
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..1*
                      BindingThe codes SHALL be taken from For codes, see StatusWaardeOMAHACodelijst
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.5--20171231000000)

                      OMAHA (2.16.840.1.113883.6.98): All values

                      TypeCoding
                      Summarytrue
                      Requirements

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

                      58. Observation.value[x]:valueCodeableConcept.coding:statusWaardeNOCCodelijst
                      Slice NamestatusWaardeNOCCodelijst
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..1*
                      BindingThe codes SHALL be taken from For codes, see StatusWaardeNOCCodelijst
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.7--20171231000000)

                      NOC (2.16.840.1.113883.6.16): All values

                      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.

                      60. Observation.value[x]:valueCodeableConcept.coding:statusWaardeICFCodelijst
                      Slice NamestatusWaardeICFCodelijst
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..1*
                      BindingThe codes SHALL be taken from For codes, see StatusWaardeICFCodelijst
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.6--20171231000000)

                      ICF (2.16.840.1.113883.6.254): All values

                      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.

                      62. Observation.value[x]:valueCodeableConcept.coding:statusWaardeSnomedCodelijst
                      Slice NamestatusWaardeSnomedCodelijst
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..1*
                      BindingThe codes SHALL be taken from For codes, see StatusWaardeSnomedCodelijst
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.8--20171231000000)

                      SNOMED CT (2.16.840.1.113883.6.96): All values

                      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.

                      64. Observation.comment
                      Definition

                      Explanatory comments as a description of the functional or mental status.


                      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

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

                      0. Observation
                      Definition

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

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

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

                      ShortLogical id of this artifact
                      Comments

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

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

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

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

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

                      ShortA set of rules under which this content was created
                      Comments

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

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

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

                      The base language in which the resource is written.

                      ShortLanguage of the resource content
                      Comments

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

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

                      A human language.

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

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

                      ShortText summary of the resource, for human interpretation
                      Comments

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

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

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

                      ShortContained, inline Resources
                      Comments

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

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

                      An Extension

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

                        Medical aid the patient has to reduce the impact of the disability or disorder.

                        ShortMedicalDevice
                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeExtension(HCIM FunctionalOrMentalStatus MedicalDevice) (Extension Type: Reference)
                        Alternate NamesHulpmiddel
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        18. Observation.modifierExtension
                        Definition

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

                        ShortExtensions that cannot be ignored
                        Comments

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

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

                        A unique identifier assigned to this observation.

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

                        Allows observations to be distinguished and referenced.

                        22. Observation.basedOn
                        Definition

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

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

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

                        Alternate NamesFulfills
                        24. Observation.status
                        Definition

                        The status of the result value.

                        Shortregistered | preliminary | final | amended +
                        Comments

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

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

                        Codes providing the status of an observation.

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

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

                        26. Observation.category
                        Definition

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

                        ShortClassification of type of observation
                        Comments

                        Either a snomed code for functional or mental status is provided for indexing and retrieval of this this concept.

                        Control1..*
                        BindingThe codes SHOULD be taken from Observation Category Codes
                        (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                        Codes for high level observation categories.

                        TypeCodeableConcept
                        Requirements

                        Used for filtering what observations are retrieved and displayed.

                        28. Observation.category.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.category.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.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 32. Observation.category.coding
                          Definition

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

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

                          Control0..*
                          TypeCoding
                          Summarytrue
                          Requirements

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

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

                            Category snomed code used for indexing/retrieval of observerd functional status.

                            ShortFunctional Finding
                            Comments

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

                            Control0..1
                            TypeCoding
                            Summarytrue
                            Requirements

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

                            36. Observation.category.coding:functionalCode.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.category.coding:functionalCode.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.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 40. Observation.category.coding:functionalCode.system
                              Definition

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

                              ShortIdentity of the terminology system
                              Comments

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

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

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

                              Fixed Valuehttp://snomed.info/sct
                              42. Observation.category.coding:functionalCode.version
                              Definition

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

                              ShortVersion of the system - if relevant
                              Comments

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

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

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

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

                              Need to refer to a particular code in the system.

                              Fixed Value118228005
                              46. Observation.category.coding:functionalCode.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.category.coding:functionalCode.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.category.coding:mentalCode
                              Slice NamementalCode
                              Definition

                              Category snomed code used for indexing/retrieval of observerd mental status.

                              ShortMental state, behavior and/or psychosocial function finding
                              Comments

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

                              Control0..1
                              TypeCoding
                              Summarytrue
                              Requirements

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

                              52. Observation.category.coding:mentalCode.id
                              Definition

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

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              54. Observation.category.coding:mentalCode.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.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 56. Observation.category.coding:mentalCode.system
                                Definition

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

                                ShortIdentity of the terminology system
                                Comments

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

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

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

                                Fixed Valuehttp://snomed.info/sct
                                58. Observation.category.coding:mentalCode.version
                                Definition

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

                                ShortVersion of the system - if relevant
                                Comments

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

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

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

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

                                Need to refer to a particular code in the system.

                                Fixed Value384821006
                                62. Observation.category.coding:mentalCode.display
                                Definition

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

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

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

                                64. Observation.category.coding:mentalCode.userSelected
                                Definition

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

                                ShortIf this coding was chosen directly by the user
                                Comments

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

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

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

                                66. Observation.category.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.

                                68. Observation.code
                                Definition

                                Coded description of the functional or mental status or limitation.

                                Code systems used include: SNOMED CT ICF (International Classification of Functioning, Disability and Health) NOC (Nursing Outcomes Classification) OMAHA

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

                                Codes identifying names of simple observations.

                                TypeCodeableConcept
                                Summarytrue
                                Requirements

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

                                Alternate NamesName, StatusNaam
                                70. 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.
                                72. Observation.code.extension
                                Definition

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

                                ShortAdditional Content defined by implementations
                                Comments

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

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

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

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

                                  Control0..*
                                  TypeCoding
                                  Summarytrue
                                  Requirements

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

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

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from StatusNaamOMAHACodelijst
                                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.1--20171231000000)

                                    OMAHA (2.16.840.1.113883.6.98): All values

                                    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.

                                    78. Observation.code.coding:statusNaamNOCCodelijst
                                    Slice NamestatusNaamNOCCodelijst
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from StatusNaamNOCCodelijst
                                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.2--20171231000000)

                                    NOC (2.16.840.1.113883.6.16): All values

                                    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.

                                    80. Observation.code.coding:statusNaamICFCodelijst
                                    Slice NamestatusNaamICFCodelijst
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from StatusNaamICFCodelijst
                                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.3--20171231000000)

                                    ICF (2.16.840.1.113883.6.254): All values

                                    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.

                                    82. Observation.code.coding:statusNaamSnomedCodelijst
                                    Slice NamestatusNaamSnomedCodelijst
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from StatusNaamSnomedCodelijst
                                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.4--20171231000000)

                                    SNOMED CT (2.16.840.1.113883.6.96): All values

                                    TypeCoding
                                    Summarytrue
                                    Requirements

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

                                    84. Observation.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.

                                    86. Observation.subject
                                    Definition

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

                                    ShortPatient
                                    Comments

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

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

                                    Control1..1
                                    TypeReference(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.

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

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

                                    ShortClinically relevant time/time-period for observation
                                    Comments

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

                                    Control0..1
                                    TypePeriod
                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                    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 are unordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 92. Observation.effective[x]:effectivePeriod
                                      Slice NameeffectivePeriod
                                      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

                                      ZIB FuncntioneleOfMentaleStatus does not include an end StatusDate. The effectivePeriod.start can be used as StatusDate. This profile allows to use an end date as well.

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

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

                                      Alternate NamesOccurrence
                                      94. Observation.effective[x]:effectivePeriod.id
                                      Definition

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

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      96. Observation.effective[x]:effectivePeriod.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.effective[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 98. Observation.effective[x]:effectivePeriod.start
                                        Definition

                                        Date on which the status was determined. A ‘vague’ date, such as only the year, is permitted.

                                        ShortStatusDate
                                        Comments

                                        If the low element is missing, the meaning is that the low boundary is not known.

                                        Control0..1
                                        This element is affected by the following invariants: per-1
                                        TypedateTime
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Alternate NamesStatusDatum
                                        100. Observation.effective[x]:effectivePeriod.end
                                        Definition

                                        The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                        ShortEnd time with inclusive boundary, if not ongoing
                                        Comments

                                        The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

                                        Control0..1
                                        This element is affected by the following invariants: per-1
                                        TypedateTime
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                        102. 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
                                        104. 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.

                                        106. 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.
                                        108. Observation.performer.extension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control0..*
                                        TypeExtension
                                        SlicingThis element introduces a set of slices on Observation.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 110. 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)
                                          112. 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
                                          114. 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
                                          116. 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
                                          118. 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
                                          TypeCodeableConcept
                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                          Summarytrue
                                          Requirements

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

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

                                            The extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical aid, the evaluation of the extent of the limitation will take place without this aid.

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

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

                                            Alternate NamesStatusWaarde
                                            122. Observation.value[x]:valueCodeableConcept.id
                                            Definition

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

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

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

                                            ShortAdditional Content defined by implementations
                                            Comments

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

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

                                              A reference to a code defined by a terminology system.

                                              ShortCode defined by a terminology system
                                              Comments

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

                                              Control0..*
                                              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.value[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ system
                                              • 128. Observation.value[x]:valueCodeableConcept.coding:statusWaardeOMAHACodelijst
                                                Slice NamestatusWaardeOMAHACodelijst
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

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

                                                Control0..1
                                                BindingThe codes SHALL be taken from StatusWaardeOMAHACodelijst
                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.5--20171231000000)

                                                OMAHA (2.16.840.1.113883.6.98): All values

                                                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.

                                                130. Observation.value[x]:valueCodeableConcept.coding:statusWaardeNOCCodelijst
                                                Slice NamestatusWaardeNOCCodelijst
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

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

                                                Control0..1
                                                BindingThe codes SHALL be taken from StatusWaardeNOCCodelijst
                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.7--20171231000000)

                                                NOC (2.16.840.1.113883.6.16): All values

                                                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.

                                                132. Observation.value[x]:valueCodeableConcept.coding:statusWaardeICFCodelijst
                                                Slice NamestatusWaardeICFCodelijst
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

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

                                                Control0..1
                                                BindingThe codes SHALL be taken from StatusWaardeICFCodelijst
                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.6--20171231000000)

                                                ICF (2.16.840.1.113883.6.254): All values

                                                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.

                                                134. Observation.value[x]:valueCodeableConcept.coding:statusWaardeSnomedCodelijst
                                                Slice NamestatusWaardeSnomedCodelijst
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

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

                                                Control0..1
                                                BindingThe codes SHALL be taken from StatusWaardeSnomedCodelijst
                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.26.8--20171231000000)

                                                SNOMED CT (2.16.840.1.113883.6.96): All values

                                                TypeCoding
                                                Summarytrue
                                                Requirements

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

                                                136. Observation.value[x]:valueCodeableConcept.text
                                                Definition

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

                                                ShortPlain text representation of the concept
                                                Comments

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

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

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

                                                138. Observation.dataAbsentReason
                                                Definition

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

                                                ShortWhy the result is missing
                                                Comments

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

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

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

                                                TypeCodeableConcept
                                                Requirements

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

                                                140. Observation.interpretation
                                                Definition

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

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

                                                Codes identifying interpretations of observations.

                                                TypeCodeableConcept
                                                Requirements

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

                                                Alternate NamesAbnormal Flag
                                                142. Observation.comment
                                                Definition

                                                Explanatory comments as a description of the functional or mental status.

                                                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
                                                144. Observation.bodySite
                                                Definition

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

                                                ShortObserved body part
                                                Comments

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

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

                                                Codes describing anatomical locations. May include laterality.

                                                TypeCodeableConcept
                                                146. Observation.method
                                                Definition

                                                Indicates the mechanism used to perform the observation.

                                                ShortHow it was done
                                                Comments

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

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

                                                Methods for simple observations.

                                                TypeCodeableConcept
                                                Requirements

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

                                                148. 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)
                                                150. 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)
                                                152. 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())
                                                154. 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.
                                                156. 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
                                                158. 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
                                                160. 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)
                                                162. 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)
                                                164. Observation.referenceRange.type
                                                Definition

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

                                                ShortReference range qualifier
                                                Comments

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

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

                                                Code for the meaning of a reference range.

                                                TypeCodeableConcept
                                                Requirements

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

                                                166. Observation.referenceRange.appliesTo
                                                Definition

                                                Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race.

                                                ShortReference range population
                                                Comments

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

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

                                                Codes identifying the population the reference range applies to.

                                                TypeCodeableConcept
                                                Requirements

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

                                                168. 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.

                                                170. 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
                                                172. 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()))
                                                174. 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.
                                                176. 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
                                                178. 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
                                                180. Observation.related.type
                                                Definition

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

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

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

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

                                                Codes specifying how two observations are related.

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

                                                A relationship type SHOULD be provided.

                                                182. 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)
                                                184. 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()))
                                                186. 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.
                                                188. 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
                                                190. 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
                                                192. Observation.component.code
                                                Definition

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

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

                                                Codes identifying names of simple observations.

                                                TypeCodeableConcept
                                                Summarytrue
                                                Requirements

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

                                                194. Observation.component.value[x]
                                                Definition

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

                                                ShortActual component result
                                                Comments

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

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

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

                                                196. Observation.component.dataAbsentReason
                                                Definition

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

                                                ShortWhy the component result is missing
                                                Comments

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

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

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

                                                TypeCodeableConcept
                                                Requirements

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

                                                198. Observation.component.interpretation
                                                Definition

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

                                                ShortHigh, low, normal, etc.
                                                Comments

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

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

                                                Codes identifying interpretations of observations.

                                                TypeCodeableConcept
                                                Requirements

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

                                                Alternate NamesAbnormal Flag
                                                200. Observation.component.referenceRange
                                                Definition

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

                                                ShortProvides guide for interpretation of component result
                                                Comments

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

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

                                                Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.