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

Active as of 2025-09-22

Definitions for the zib-LaboratoryTestResult-Observation resource profile.

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

0. Observation
Definition

A laboratory result describes the result of a laboratory analysis. These are specimen-oriented tests as performed in laboratories such as Clinical Chemistry, Serology, Microbiology, etc. In addition to the results of tests with a singular result, this concept can also contain the results of more complex tests with multiple results or a ‘panel’.

ShortLaboratoryTestResult
Comments

This profile is used for two concepts of the HCIM LaboratoryTestResult at the same time: the root concept (NL-CM:13.1.1) and the LaboratoryTest concept (NL-CM:13.1.3). A LaboratoryTestResult can consist of just one LaboratoryTest or can be a panel of multiple LaboratoryTests. If there's just one LaboratoryTest, a single instance of this profile may be used to represent both concepts, but if there are multiple LaboratoryTests, there should be one parent instance representing the LaboratoryTestResult that uses Observation.related to link child instances representing individual LaboratoryTests.

Note that the Observation.related field in is also used for a third case where there are multiple related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33).

The list below summarizes the different situations: 1. Single LaboratoryTestResult with single LaboratoryTest: * single instance of this profile * .code represents the HCIM concept TestCode (NL-CM:13.1.8) 2. Single LaboratoryTestResult with multiple LaboratoryTests * parent instance with child instances in .related.target * .code of parent represents the HCIM concept PanelOrBattery (NL-CM:13.1.4) * .code of child represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.type of parent set to "has-member" 3. Multiple related LaboratoryTestResults * multiple instances representing the root concept * .code represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.target references the related instances * .related.type set to whichever value is appropriate

Also note that there is the additional profile zib-LaboratoryTestResult-DiagnosticReport, which is used for (textual) reports on individual (panels of) observations, like conclusions. The DiagnosticReport contains references to instances of this profile and can be used in all three the situations described above.

Alternate NamesLaboratoriumUitslag
2. Observation.identifier
ShortIdentifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Alternate NamesIdentificatie
4. Observation.basedOn
ShortFulfills plan, proposal or order including requester information.
Comments

Requester information should be captured and exchanged in the resource ProcedureRequest referenced by basedOn. Requester is the healthcare provider and/or organization where or by whom the LaboratoryTestResult was requested. There are a few required elements in ProcedureRequest: * ProcedureRequest.status (use fixed value active, unless you know what the actual value is) * ProcedureRequest.intent (use fixed value order, unless you know what the actual value is) * ProcedureRequest.code (use extension http://hl7.org/fhir/STU3/extension-iso21090-nullflavor.html with valueCode UNK, unless you know what the actual value is) * ProcedureRequest.subject (equal to Observation.subject) * ProcedureRequest.requester.agent (contains the requesting HealthProfessional)

Alternate NamesAanvrager
6. Observation.status
Definition

The status of the test result of this test. If the laboratory test is an panel/cluster, the overall status is given in the status of the panel/cluster.

ShortTestUitslagStatus
Alternate NamesTestUitslagStatus
8. Observation.status.extension
SlicingThis element introduces a set of slices on Observation.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 10. Observation.status.extension:TestResultStatus
    Slice NameTestResultStatus
    Definition

    Provides the specific HCIM code for TestResultStatus or ResultStatus.

    The status of the laboratory test result. If the laboratory test is an panel/cluster, this status reflects the status of the whole panel/cluster. If the status item per subtest is used too, this status must be in accordance with these status values.

    ShortTestResultStatus
    Control0..1
    TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
    Alternate NamesTestUitslagStatus
    12. Observation.status.extension:TestResultStatus.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    BindingUnless not suitable, these codes SHALL be taken from ResultaatStatusCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000)

    TestResultStatusCodelist

    14. Observation.category
    Control1..?
    SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ $this
    • 16. Observation.category:LaboratoryTestResultCode
      Slice NameLaboratoryTestResultCode
      ShortLaboratoryTestResultCode
      Control1..1
      Pattern Value{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "49581000146104"
        }]
      }
      18. Observation.category:LaboratoryTestResultCode.coding
      20. Observation.category:LaboratoryTestResultCode.coding.display
      Default ValueLaboratory test finding (finding)
      22. Observation.category:ResultType
      Slice NameResultType
      Definition

      The type of result defines the laboratory specialty under which the test is categorized.

      ShortResultType
      Control0..1
      BindingThe codes SHALL be taken from ResultaatTypeCodelijst
      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000)

      ResultaatTypeCodelijst

      Alternate NamesResultaatType
      24. Observation.code
      Definition

      The name and code of the executed test or for laboratory tests comprising multiple subtests and often requested together as a whole, this concept contains the name of the compound request (often indicated as a ‘panel’, ‘battery’ or ‘cluster’). Examples include: blood gases and EBV serology.

      ShortTestCode or PanelOrBattery
      Comments

      This can either be the HCIM concept PanelOrBattery (NL-CM:13.1.4) or TestCode (NL-CM:13.1.8) depending on the use case. See the documentation on the root of this profile for guidance on implementing the different uses cases.

      Alternate NamesTestCode, Onderzoek
      26. Observation.subject
      ShortPatient
      Alternate NamesPatiënt
      28. Observation.context
      Definition

      The encounter during which this journal entry was made.

      ShortEncounter during which this observation is made
      30. Observation.effective[x]
      Definition

      The date and if possible the time at which the test was carried out.

      ShortTestDateTime
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Alternate NamesTestDatumTijd
      32. Observation.value[x]
      Definition

      The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

      ShortTestResult
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Alternate NamesTestUitslag
      34. Observation.interpretation
      36. Observation.interpretation.coding
      Control1..?
      Invariantszib-LaboratoryTestResult-Observation-1: If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values. (coding.where(system = 'http://snomed.info/sct' and (code = '281302008' or '281300000' or '11896004' or '30714006' or '131196009') ).exists() implies coding.where(system = 'http://hl7.org/fhir/v2/0078').exists())
      SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 38. Observation.interpretation.coding:ObservationInterpretation
        Slice NameObservationInterpretation
        BindingThe codes SHALL be taken from Observation Interpretation Codes
        (required to http://hl7.org/fhir/ValueSet/observation-interpretation)

        Observation Interpretation Codes

        40. Observation.interpretation.coding:ObservationInterpretation.system
        Control1..?
        Fixed Valuehttp://hl7.org/fhir/v2/0078
        42. Observation.interpretation.coding:ObservationInterpretation.code
        Control1..?
        44. Observation.interpretation.coding:InterpretatieVlaggenCodelijst
        Slice NameInterpretatieVlaggenCodelijst
        Definition

        Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

        ShortResultFlags
        Comments

        This slice binds the ValueSet from the HCIM, which overlaps the ValueSet from the core FHIR Observation. To satisfy the FHIR profiling rules, the code from the core FHIR ValueSet SHOULD be included as well if a code from this ValueSet is included. A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that explains the relationship between the FHIR observation-interpretation value set and the HCIM ResultFlagsCodelist.

        BindingThe codes SHALL be taken from InterpretatieVlaggenCodelijst
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

        InterpretatieVlaggenCodelijst

        Alternate NamesInterpretatieVlaggen
        46. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.system
        Control1..?
        Fixed Valuehttp://snomed.info/sct
        48. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.code
        Control1..?
        50. Observation.comment
        Definition

        Comments, such as a textual interpretation or advice accompanying the result, for example or a comment of the laboratory specialist regarding the interpretation of the results.

        ShortComment or ResultInterpretation
        Alternate NamesToelichting, UitslagInterpretatie
        52. Observation.method
        Definition

        The test method used to obtain the result.

        ShortTestMethod
        BindingUnless not suitable, these codes SHALL be taken from TestmethodeCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.4--20171231000000)

        SNOMED CT (2.16.840.1.113883.6.96): All values

        Alternate NamesTestmethode
        54. Observation.specimen
        ShortSpecimen
        TypeReference(HCIM LaboratoryTestResult Specimen, HCIM LaboratoryTestResult Specimen Isolate)
        Alternate NamesMonster
        56. Observation.device
        TypeReference(HCIM MedicalDevice Product)
        58. Observation.referenceRange
        ShortReference
        Alternate NamesReferentie
        60. Observation.referenceRange.low
        Definition

        The lower reference limit for the patient of the value measured with the test.

        ShortReferenceRangeLowerLimit
        Alternate NamesReferentieOndergrens
        62. Observation.referenceRange.high
        Definition

        The upper reference limit for the patient of the value measured in the test.

        ShortReferenceRangeUpperLimit
        Alternate NamesReferentieBovengrens
        64. Observation.related
        Definition

        Reference to related LaboratoryTestResult instances, or to the LaboratoryTest concept if this is a grouping Observation.

        ShortRelatedResults
        Comments

        The Observation.related field is used for two different HCIM use cases: 1. The LaboratoryTestResult can reference other, related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33). 2. The LaboratoryTestResult can consist of multiple LaboratoryTest concepts (NL-CM:13.1.3)

        See the documentation on the root if this profile for guidance on implementing these use cases.

        Alternate NamesGerelateerdeUitslag, LaboratoriumTest
        66. Observation.related.target
        TypeReference(QuestionnaireResponse, Sequence, HCIM LaboratoryTestResult Observation)
        68. Observation.component
        Definition

        Container of the LaboratoryTest concept. This container contains all data elements of the LaboratoryTest concept.

        ShortLaboratoryTest
        Alternate NamesLaboratoriumTest
        70. Observation.component.code
        Definition

        The TestCode is the name of the executed test.

        ShortTestCode
        BindingUnless not suitable, these codes SHALL be taken from TestCodeCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.3--20171231000000)

        LOINC (2.16.840.1.113883.6.1): All values

        Alternate NamesTestCode
        72. Observation.component.value[x]
        Definition

        The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

        ShortTestResult
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Alternate NamesTestUitslag
        74. Observation.component.interpretation
        Definition

        Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

        ShortResultFlags
        Comments

        A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that maps ResultFlagsCodelist to the observation-interpretation value set.

        BindingUnless not suitable, these codes SHALL be taken from InterpretatieVlaggenCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

        InterpretatieVlaggenCodelijst

        Alternate NamesInterpretatieVlaggen

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

        0. Observation
        Definition

        A laboratory result describes the result of a laboratory analysis. These are specimen-oriented tests as performed in laboratories such as Clinical Chemistry, Serology, Microbiology, etc. In addition to the results of tests with a singular result, this concept can also contain the results of more complex tests with multiple results or a ‘panel’.


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

        ShortLaboratoryTestResultMeasurements and simple assertions
        Comments

        This profile is used for two concepts of the HCIM LaboratoryTestResult at the same time: the root concept (NL-CM:13.1.1) and the LaboratoryTest concept (NL-CM:13.1.3). A LaboratoryTestResult can consist of just one LaboratoryTest or can be a panel of multiple LaboratoryTests. If there's just one LaboratoryTest, a single instance of this profile may be used to represent both concepts, but if there are multiple LaboratoryTests, there should be one parent instance representing the LaboratoryTestResult that uses Observation.related to link child instances representing individual LaboratoryTests.

        Note that the Observation.related field in is also used for a third case where there are multiple related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33).

        The list below summarizes the different situations: 1. Single LaboratoryTestResult with single LaboratoryTest: * single instance of this profile * .code represents the HCIM concept TestCode (NL-CM:13.1.8) 2. Single LaboratoryTestResult with multiple LaboratoryTests * parent instance with child instances in .related.target * .code of parent represents the HCIM concept PanelOrBattery (NL-CM:13.1.4) * .code of child represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.type of parent set to "has-member" 3. Multiple related LaboratoryTestResults * multiple instances representing the root concept * .code represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.target references the related instances * .related.type set to whichever value is appropriate

        Also note that there is the additional profile zib-LaboratoryTestResult-DiagnosticReport, which is used for (textual) reports on individual (panels of) observations, like conclusions. The DiagnosticReport contains references to instances of this profile and can be used in all three the situations described above.


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

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

        ShortA set of rules under which this content was created
        Comments

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

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

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

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

        ShortExtensions that cannot be ignored
        Comments

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

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

        A unique identifier assigned to this observation.

        ShortIdentifierBusiness 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.

        Alternate NamesIdentificatie
        8. Observation.basedOn
        Definition

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

        ShortFulfills plan, proposal or order including requester information.
        Comments

        Requester information should be captured and exchanged in the resource ProcedureRequest referenced by basedOn. Requester is the healthcare provider and/or organization where or by whom the LaboratoryTestResult was requested. There are a few required elements in ProcedureRequest: * ProcedureRequest.status (use fixed value active, unless you know what the actual value is) * ProcedureRequest.intent (use fixed value order, unless you know what the actual value is) * ProcedureRequest.code (use extension http://hl7.org/fhir/STU3/extension-iso21090-nullflavor.html with valueCode UNK, unless you know what the actual value is) * ProcedureRequest.subject (equal to Observation.subject) * ProcedureRequest.requester.agent (contains the requesting HealthProfessional)

        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, Aanvrager
        10. Observation.status
        Definition

        The status of the test result of this test. If the laboratory test is an panel/cluster, the overall status is given in the status of the panel/cluster.


        The status of the result value.

        ShortTestUitslagStatusregistered | preliminary | final | amended +
        Comments

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

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

        Codes providing the status of an observation.

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

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

        Alternate NamesTestUitslagStatus
        12. Observation.status.extension
        Definition

        An Extension


        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.

        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.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 14. Observation.status.extension:TestResultStatus
          Slice NameTestResultStatus
          Definition

          Provides the specific HCIM code for TestResultStatus or ResultStatus.

          The status of the laboratory test result. If the laboratory test is an panel/cluster, this status reflects the status of the whole panel/cluster. If the status item per subtest is used too, this status must be in accordance with these status values.

          ShortTestResultStatus
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
          Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., TestUitslagStatus
          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())
          16. Observation.status.extension:TestResultStatus.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          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.
          Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
          18. Observation.status.extension:TestResultStatus.value[x]
          Definition

          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

          ShortValue of extension
          Control10..1
          TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          SlicingThis element introduces a set of slices on Observation.status.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 20. Observation.status.extension:TestResultStatus.value[x]:valueCodeableConcept
            Slice NamevalueCodeableConcept
            Definition

            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

            ShortValue of extension
            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see ResultaatStatusCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000)

            TestResultStatusCodelist

            TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            22. Observation.category
            Definition

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

            ShortClassification of type of observation
            Comments

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

            Control10..*
            BindingThe codes SHOULD be taken from Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category|3.0.2
            (preferred to http://hl7.org/fhir/ValueSet/observation-category|3.0.2)

            Codes for high level observation categories.

            TypeCodeableConcept
            Requirements

            Used for filtering what observations are retrieved and displayed.

            SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ $this
            • 24. Observation.category:LaboratoryTestResultCode
              Slice NameLaboratoryTestResultCode
              Definition

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

              ShortLaboratoryTestResultCodeClassification of type of observation
              Comments

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

              Control10..1*
              BindingThe codes SHOULD be taken from Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category|3.0.2
              (preferred to http://hl7.org/fhir/ValueSet/observation-category|3.0.2)

              Codes for high level observation categories.

              TypeCodeableConcept
              Requirements

              Used for filtering what observations are retrieved and displayed.

              Pattern Value{
                "coding" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "49581000146104"
                }]
              }
              26. Observation.category:ResultType
              Slice NameResultType
              Definition

              The type of result defines the laboratory specialty under which the test is categorized.


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

              ShortResultTypeClassification of type of observation
              Comments

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

              Control0..1*
              BindingThe codes SHALL be taken from The codes SHOULD be taken from ResultaatTypeCodelijsthttp://hl7.org/fhir/ValueSet/observation-category|3.0.2
              (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000)

              ResultaatTypeCodelijst


              Codes for high level observation categories.

              TypeCodeableConcept
              Requirements

              Used for filtering what observations are retrieved and displayed.

              Alternate NamesResultaatType
              28. Observation.code
              Definition

              The name and code of the executed test or for laboratory tests comprising multiple subtests and often requested together as a whole, this concept contains the name of the compound request (often indicated as a ‘panel’, ‘battery’ or ‘cluster’). Examples include: blood gases and EBV serology.


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

              ShortTestCode or PanelOrBatteryType of observation (code / type)
              Comments

              This can either be the HCIM concept PanelOrBattery (NL-CM:13.1.4) or TestCode (NL-CM:13.1.8) depending on the use case. See the documentation on the root of this profile for guidance on implementing the different uses cases.

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

              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Alternate NamesName, TestCode, Onderzoek
              30. 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
              32. Observation.context
              Definition

              The encounter during which this journal entry was made.


              The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

              ShortEncounter during which this observation is madeHealthcare 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, Encounter, EpisodeOfCare)
              Requirements

              For some observations it may be important to know the link between an observation and a particular encounter.

              Alternate NamesEncounter
              34. Observation.effective[x]
              Definition

              The date and if possible the time at which the test was carried out.


              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.

              ShortTestDateTimeClinically relevant time/time-period for observation
              Comments

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

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

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

              Alternate NamesOccurrence, TestDatumTijd
              36. Observation.value[x]
              Definition

              The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).


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

              ShortTestResultActual result
              Comments

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

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

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

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

              Alternate NamesTestUitslag
              38. Observation.comment
              Definition

              Comments, such as a textual interpretation or advice accompanying the result, for example or a comment of the laboratory specialist regarding the interpretation of the results.


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

              ShortComment or ResultInterpretationComments 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, UitslagInterpretatie
              40. Observation.method
              Definition

              The test method used to obtain the result.


              Indicates the mechanism used to perform the observation.

              ShortTestMethodHow it was done
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from For example codes, see TestmethodeCodelijsthttp://hl7.org/fhir/ValueSet/observation-methods|3.0.2
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.4--20171231000000)

              SNOMED CT (2.16.840.1.113883.6.96): All values


              Methods for simple observations.

              TypeCodeableConcept
              Requirements

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

              Alternate NamesTestmethode
              42. Observation.specimen
              Definition

              The specimen that was used when this observation was made.

              ShortSpecimenSpecimen 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(HCIM LaboratoryTestResult Specimen, HCIM LaboratoryTestResult Specimen Isolate, Specimen)
              Alternate NamesMonster
              44. Observation.device
              Definition

              The device used to generate the observation data.

              Short(Measurement) Device
              Comments

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

              Control0..1
              TypeReference(HCIM MedicalDevice Product, Device, DeviceMetric)
              46. Observation.referenceRange
              Definition

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

              ShortReferenceProvides 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.

              Alternate NamesReferentie
              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())
              ele-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())
              48. 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
              50. Observation.referenceRange.low
              Definition

              The lower reference limit for the patient of the value measured with the test.


              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).

              ShortReferenceRangeLowerLimitLow Range, if relevant
              Control0..1
              This element is affected by the following invariants: obs-3
              TypeQuantity(SimpleQuantity)
              Alternate NamesReferentieOndergrens
              52. Observation.referenceRange.high
              Definition

              The upper reference limit for the patient of the value measured in the test.


              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).

              ShortReferenceRangeUpperLimitHigh Range, if relevant
              Control0..1
              This element is affected by the following invariants: obs-3
              TypeQuantity(SimpleQuantity)
              Alternate NamesReferentieBovengrens
              54. Observation.related
              Definition

              Reference to related LaboratoryTestResult instances, or to the LaboratoryTest concept if this is a grouping Observation.


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

              ShortRelatedResultsResource related to this observation
              Comments

              The Observation.related field is used for two different HCIM use cases: 1. The LaboratoryTestResult can reference other, related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33). 2. The LaboratoryTestResult can consist of multiple LaboratoryTest concepts (NL-CM:13.1.3)

              See the documentation on the root if this profile for guidance on implementing these use cases.


              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.

              Alternate NamesGerelateerdeUitslag, LaboratoriumTest
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              56. Observation.related.modifierExtension
              Definition

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

              ShortExtensions that cannot be ignored
              Comments

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

              Control0..*
              TypeExtension
              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
              Summarytrue
              Alternate Namesextensions, user content, modifiers
              58. Observation.related.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(QuestionnaireResponse, Sequence, HCIM LaboratoryTestResult Observation, Observation)
              60. Observation.component
              Definition

              Container of the LaboratoryTest concept. This container contains all data elements of the LaboratoryTest concept.


              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.

              ShortLaboratoryTestComponent 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.

              Alternate NamesLaboratoriumTest
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              62. 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
              64. Observation.component.code
              Definition

              The TestCode is the name of the executed test.


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

              ShortTestCodeType of component observation (code / type)
              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from For example codes, see TestCodeCodelijsthttp://hl7.org/fhir/ValueSet/observation-codes|3.0.2
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.3--20171231000000)

              LOINC (2.16.840.1.113883.6.1): All values


              Codes identifying names of simple observations.

              TypeCodeableConcept
              Summarytrue
              Requirements

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

              Alternate NamesTestCode
              66. Observation.component.value[x]
              Definition

              The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).


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

              ShortTestResultActual component result
              Comments

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

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

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

              Alternate NamesTestUitslag
              68. Observation.component.interpretation
              Definition

              Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)


              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.

              ShortResultFlagsHigh, low, normal, etc.
              Comments

              A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that maps ResultFlagsCodelist to the observation-interpretation value set.


              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 InterpretatieVlaggenCodelijsthttp://hl7.org/fhir/ValueSet/observation-interpretation|3.0.2
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

              InterpretatieVlaggenCodelijst


              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, InterpretatieVlaggen

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

              0. Observation
              Definition

              A laboratory result describes the result of a laboratory analysis. These are specimen-oriented tests as performed in laboratories such as Clinical Chemistry, Serology, Microbiology, etc. In addition to the results of tests with a singular result, this concept can also contain the results of more complex tests with multiple results or a ‘panel’.

              ShortLaboratoryTestResult
              Comments

              This profile is used for two concepts of the HCIM LaboratoryTestResult at the same time: the root concept (NL-CM:13.1.1) and the LaboratoryTest concept (NL-CM:13.1.3). A LaboratoryTestResult can consist of just one LaboratoryTest or can be a panel of multiple LaboratoryTests. If there's just one LaboratoryTest, a single instance of this profile may be used to represent both concepts, but if there are multiple LaboratoryTests, there should be one parent instance representing the LaboratoryTestResult that uses Observation.related to link child instances representing individual LaboratoryTests.

              Note that the Observation.related field in is also used for a third case where there are multiple related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33).

              The list below summarizes the different situations: 1. Single LaboratoryTestResult with single LaboratoryTest: * single instance of this profile * .code represents the HCIM concept TestCode (NL-CM:13.1.8) 2. Single LaboratoryTestResult with multiple LaboratoryTests * parent instance with child instances in .related.target * .code of parent represents the HCIM concept PanelOrBattery (NL-CM:13.1.4) * .code of child represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.type of parent set to "has-member" 3. Multiple related LaboratoryTestResults * multiple instances representing the root concept * .code represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.target references the related instances * .related.type set to whichever value is appropriate

              Also note that there is the additional profile zib-LaboratoryTestResult-DiagnosticReport, which is used for (textual) reports on individual (panels of) observations, like conclusions. The DiagnosticReport contains references to instances of this profile and can be used in all three the situations described above.

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

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

              ShortLogical id of this artifact
              Comments

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

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

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

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

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

              ShortA set of rules under which this content was created
              Comments

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

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

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

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

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

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from Common Languages
              (extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)

              A human language.

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

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

              ShortText summary of the resource, for human interpretation
              Comments

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

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

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

              ShortContained, inline Resources
              Comments

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

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

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

              ShortAdditional Content defined by implementations
              Comments

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

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

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

              ShortExtensions that cannot be ignored
              Comments

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

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

              A unique identifier assigned to this observation.

              ShortIdentifier
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Summarytrue
              Requirements

              Allows observations to be distinguished and referenced.

              Alternate NamesIdentificatie
              20. Observation.basedOn
              Definition

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

              ShortFulfills plan, proposal or order including requester information.
              Comments

              Requester information should be captured and exchanged in the resource ProcedureRequest referenced by basedOn. Requester is the healthcare provider and/or organization where or by whom the LaboratoryTestResult was requested. There are a few required elements in ProcedureRequest: * ProcedureRequest.status (use fixed value active, unless you know what the actual value is) * ProcedureRequest.intent (use fixed value order, unless you know what the actual value is) * ProcedureRequest.code (use extension http://hl7.org/fhir/STU3/extension-iso21090-nullflavor.html with valueCode UNK, unless you know what the actual value is) * ProcedureRequest.subject (equal to Observation.subject) * ProcedureRequest.requester.agent (contains the requesting HealthProfessional)

              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, Aanvrager
              22. Observation.status
              Definition

              The status of the test result of this test. If the laboratory test is an panel/cluster, the overall status is given in the status of the panel/cluster.

              ShortTestUitslagStatus
              Comments

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

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

              Codes providing the status of an observation.

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

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

              Alternate NamesTestUitslagStatus
              24. Observation.status.id
              Definition

              unique id for the element within a resource (for internal references)

              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.
              26. Observation.status.extension
              Definition

              An Extension

              ShortExtension
              Control0..*
              TypeExtension
              SlicingThis element introduces a set of slices on Observation.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 28. Observation.status.extension:TestResultStatus
                Slice NameTestResultStatus
                Definition

                Provides the specific HCIM code for TestResultStatus or ResultStatus.

                The status of the laboratory test result. If the laboratory test is an panel/cluster, this status reflects the status of the whole panel/cluster. If the status item per subtest is used too, this status must be in accordance with these status values.

                ShortTestResultStatus
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., TestUitslagStatus
                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())
                30. Observation.status.extension:TestResultStatus.id
                Definition

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

                Shortxml:id (or equivalent in JSON)
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                32. Observation.status.extension:TestResultStatus.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.status.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 34. Observation.status.extension:TestResultStatus.url
                  Definition

                  Source of the definition for the extension code - a logical name or a URL.

                  Shortidentifies the meaning of the extension
                  Comments

                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                  Control1..1
                  Typeuri
                  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.
                  Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
                  36. Observation.status.extension:TestResultStatus.value[x]
                  Definition

                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                  ShortValue of extension
                  Control1..1
                  TypeCodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  SlicingThis element introduces a set of slices on Observation.status.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 38. Observation.status.extension:TestResultStatus.value[x]:valueCodeableConcept
                    Slice NamevalueCodeableConcept
                    Definition

                    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                    ShortValue of extension
                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from ResultaatStatusCodelijst
                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000)

                    TestResultStatusCodelist

                    TypeCodeableConcept
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    40. Observation.status.value
                    Definition

                    Primitive value for code

                    ShortPrimitive value for code
                    Control0..1
                    Typecode
                    XML FormatIn the XML format, this property is represented as an attribute.
                    42. Observation.category
                    Definition

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

                    ShortClassification of type of observation
                    Comments

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

                    Control1..*
                    BindingThe codes SHOULD be taken from Observation Category Codes
                    (preferred to http://hl7.org/fhir/ValueSet/observation-category|3.0.2)

                    Codes for high level observation categories.

                    TypeCodeableConcept
                    Requirements

                    Used for filtering what observations are retrieved and displayed.

                    SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ $this
                    • 44. Observation.category:LaboratoryTestResultCode
                      Slice NameLaboratoryTestResultCode
                      Definition

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

                      ShortLaboratoryTestResultCode
                      Comments

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

                      Control1..1
                      BindingThe codes SHOULD be taken from Observation Category Codes
                      (preferred to http://hl7.org/fhir/ValueSet/observation-category|3.0.2)

                      Codes for high level observation categories.

                      TypeCodeableConcept
                      Requirements

                      Used for filtering what observations are retrieved and displayed.

                      Pattern Value{
                        "coding" : [{
                          "system" : "http://snomed.info/sct",
                          "code" : "49581000146104"
                        }]
                      }
                      46. Observation.category:LaboratoryTestResultCode.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.
                      48. Observation.category:LaboratoryTestResultCode.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 areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 50. Observation.category:LaboratoryTestResultCode.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.

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

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

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

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

                        ShortAdditional Content defined by implementations
                        Comments

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

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

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

                          ShortIdentity of the terminology system
                          Comments

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

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

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

                          58. Observation.category:LaboratoryTestResultCode.coding.version
                          Definition

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

                          ShortVersion of the system - if relevant
                          Comments

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

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

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

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

                          Need to refer to a particular code in the system.

                          62. Observation.category:LaboratoryTestResultCode.coding.display
                          Definition

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

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

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

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

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

                          ShortIf this coding was chosen directly by the user
                          Comments

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

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

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

                          66. Observation.category:LaboratoryTestResultCode.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.category:ResultType
                          Slice NameResultType
                          Definition

                          The type of result defines the laboratory specialty under which the test is categorized.

                          ShortResultType
                          Comments

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

                          Control0..1
                          BindingThe codes SHALL be taken from ResultaatTypeCodelijst
                          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000)

                          ResultaatTypeCodelijst

                          TypeCodeableConcept
                          Requirements

                          Used for filtering what observations are retrieved and displayed.

                          Alternate NamesResultaatType
                          70. Observation.code
                          Definition

                          The name and code of the executed test or for laboratory tests comprising multiple subtests and often requested together as a whole, this concept contains the name of the compound request (often indicated as a ‘panel’, ‘battery’ or ‘cluster’). Examples include: blood gases and EBV serology.

                          ShortTestCode or PanelOrBattery
                          Comments

                          This can either be the HCIM concept PanelOrBattery (NL-CM:13.1.4) or TestCode (NL-CM:13.1.8) depending on the use case. See the documentation on the root of this profile for guidance on implementing the different uses cases.

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

                          Codes identifying names of simple observations.

                          TypeCodeableConcept
                          Summarytrue
                          Requirements

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

                          Alternate NamesName, TestCode, Onderzoek
                          72. 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
                          74. Observation.context
                          Definition

                          The encounter during which this journal entry was made.

                          ShortEncounter 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
                          76. Observation.effective[x]
                          Definition

                          The date and if possible the time at which the test was carried out.

                          ShortTestDateTime
                          Comments

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

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

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

                          Alternate NamesOccurrence, TestDatumTijd
                          78. 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
                          80. 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.

                          82. 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.
                          84. Observation.performer.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..*
                          TypeExtension
                          SlicingThis element introduces a set of slices on Observation.performer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 86. 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)
                            88. 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
                            90. 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
                            92. 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
                            94. Observation.value[x]
                            Definition

                            The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

                            ShortTestResult
                            Comments

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

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

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

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

                            Alternate NamesTestUitslag
                            96. Observation.dataAbsentReason
                            Definition

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

                            ShortWhy the result is missing
                            Comments

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

                            Control0..1
                            This element is affected by the following invariants: obs-6
                            BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                            (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason|3.0.2)

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

                            TypeCodeableConcept
                            Requirements

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

                            98. Observation.interpretation
                            Definition

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

                            ShortHigh, low, normal, etc.
                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                            (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation|3.0.2)

                            Codes identifying interpretations of observations.

                            TypeCodeableConcept
                            Requirements

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

                            Alternate NamesAbnormal Flag
                            100. Observation.interpretation.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.
                            102. Observation.interpretation.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.interpretation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 104. Observation.interpretation.coding
                              Definition

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

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

                              Control1..*
                              TypeCoding
                              Summarytrue
                              Requirements

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

                              Invariantszib-LaboratoryTestResult-Observation-1: If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values. (coding.where(system = 'http://snomed.info/sct' and (code = '281302008' or '281300000' or '11896004' or '30714006' or '131196009') ).exists() implies coding.where(system = 'http://hl7.org/fhir/v2/0078').exists())
                              SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ system
                              • 106. Observation.interpretation.coding:ObservationInterpretation
                                Slice NameObservationInterpretation
                                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..*
                                BindingThe codes SHALL be taken from Observation Interpretation Codes
                                (required to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                Observation Interpretation Codes

                                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.

                                108. Observation.interpretation.coding:ObservationInterpretation.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.
                                110. Observation.interpretation.coding:ObservationInterpretation.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.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 112. Observation.interpretation.coding:ObservationInterpretation.system
                                  Definition

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

                                  ShortIdentity of the terminology system
                                  Comments

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

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

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

                                  Fixed Valuehttp://hl7.org/fhir/v2/0078
                                  114. Observation.interpretation.coding:ObservationInterpretation.version
                                  Definition

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

                                  ShortVersion of the system - if relevant
                                  Comments

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

                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  116. Observation.interpretation.coding:ObservationInterpretation.code
                                  Definition

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

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

                                  Need to refer to a particular code in the system.

                                  118. Observation.interpretation.coding:ObservationInterpretation.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.

                                  120. Observation.interpretation.coding:ObservationInterpretation.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.

                                  122. Observation.interpretation.coding:InterpretatieVlaggenCodelijst
                                  Slice NameInterpretatieVlaggenCodelijst
                                  Definition

                                  Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

                                  ShortResultFlags
                                  Comments

                                  This slice binds the ValueSet from the HCIM, which overlaps the ValueSet from the core FHIR Observation. To satisfy the FHIR profiling rules, the code from the core FHIR ValueSet SHOULD be included as well if a code from this ValueSet is included. A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that explains the relationship between the FHIR observation-interpretation value set and the HCIM ResultFlagsCodelist.

                                  Control0..*
                                  BindingThe codes SHALL be taken from InterpretatieVlaggenCodelijst
                                  (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

                                  InterpretatieVlaggenCodelijst

                                  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.

                                  Alternate NamesInterpretatieVlaggen
                                  124. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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.
                                  126. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 128. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.system
                                    Definition

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

                                    ShortIdentity of the terminology system
                                    Comments

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

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

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

                                    Fixed Valuehttp://snomed.info/sct
                                    130. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.version
                                    Definition

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

                                    ShortVersion of the system - if relevant
                                    Comments

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

                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    132. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.code
                                    Definition

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

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

                                    Need to refer to a particular code in the system.

                                    134. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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.

                                    136. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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.

                                    138. Observation.interpretation.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.

                                    140. Observation.comment
                                    Definition

                                    Comments, such as a textual interpretation or advice accompanying the result, for example or a comment of the laboratory specialist regarding the interpretation of the results.

                                    ShortComment or ResultInterpretation
                                    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, UitslagInterpretatie
                                    142. Observation.bodySite
                                    Definition

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

                                    ShortObserved body part
                                    Comments

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

                                    Control0..1
                                    BindingFor example codes, see SNOMED CT Body Structures
                                    (example to http://hl7.org/fhir/ValueSet/body-site|3.0.2)

                                    Codes describing anatomical locations. May include laterality.

                                    TypeCodeableConcept
                                    144. Observation.method
                                    Definition

                                    The test method used to obtain the result.

                                    ShortTestMethod
                                    Comments

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

                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from TestmethodeCodelijst
                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.4--20171231000000)

                                    SNOMED CT (2.16.840.1.113883.6.96): All values

                                    TypeCodeableConcept
                                    Requirements

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

                                    Alternate NamesTestmethode
                                    146. Observation.specimen
                                    Definition

                                    The specimen that was used when this observation was made.

                                    ShortSpecimen
                                    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(HCIM LaboratoryTestResult Specimen, HCIM LaboratoryTestResult Specimen Isolate)
                                    Alternate NamesMonster
                                    148. Observation.device
                                    Definition

                                    The device used to generate the observation data.

                                    Short(Measurement) Device
                                    Comments

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

                                    Control0..1
                                    TypeReference(HCIM MedicalDevice Product)
                                    150. Observation.referenceRange
                                    Definition

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

                                    ShortReference
                                    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.

                                    Alternate NamesReferentie
                                    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())
                                    152. 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.
                                    154. 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
                                    156. 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
                                    158. Observation.referenceRange.low
                                    Definition

                                    The lower reference limit for the patient of the value measured with the test.

                                    ShortReferenceRangeLowerLimit
                                    Control0..1
                                    This element is affected by the following invariants: obs-3
                                    TypeQuantity(SimpleQuantity)
                                    Alternate NamesReferentieOndergrens
                                    160. Observation.referenceRange.high
                                    Definition

                                    The upper reference limit for the patient of the value measured in the test.

                                    ShortReferenceRangeUpperLimit
                                    Control0..1
                                    This element is affected by the following invariants: obs-3
                                    TypeQuantity(SimpleQuantity)
                                    Alternate NamesReferentieBovengrens
                                    162. Observation.referenceRange.type
                                    Definition

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

                                    ShortReference range qualifier
                                    Comments

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

                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from Observation Reference Range Meaning Codes
                                    (extensible to http://hl7.org/fhir/ValueSet/referencerange-meaning|3.0.2)

                                    Code for the meaning of a reference range.

                                    TypeCodeableConcept
                                    Requirements

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

                                    164. Observation.referenceRange.appliesTo
                                    Definition

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

                                    ShortReference range population
                                    Comments

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

                                    Control0..*
                                    BindingFor example codes, see Observation Reference Range Applies To Codes
                                    (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto|3.0.2)

                                    Codes identifying the population the reference range applies to.

                                    TypeCodeableConcept
                                    Requirements

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

                                    166. 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.

                                    168. 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
                                    170. Observation.related
                                    Definition

                                    Reference to related LaboratoryTestResult instances, or to the LaboratoryTest concept if this is a grouping Observation.

                                    ShortRelatedResults
                                    Comments

                                    The Observation.related field is used for two different HCIM use cases: 1. The LaboratoryTestResult can reference other, related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33). 2. The LaboratoryTestResult can consist of multiple LaboratoryTest concepts (NL-CM:13.1.3)

                                    See the documentation on the root if this profile for guidance on implementing these use cases.

                                    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.

                                    Alternate NamesGerelateerdeUitslag, LaboratoriumTest
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                    172. 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.
                                    174. 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
                                    176. 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
                                    178. Observation.related.type
                                    Definition

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

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

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from ObservationRelationshipType
                                    (required to http://hl7.org/fhir/ValueSet/observation-relationshiptypes|3.0.2)

                                    Codes specifying how two observations are related.

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

                                    A relationship type SHOULD be provided.

                                    180. 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(QuestionnaireResponse, Sequence, HCIM LaboratoryTestResult Observation)
                                    182. Observation.component
                                    Definition

                                    Container of the LaboratoryTest concept. This container contains all data elements of the LaboratoryTest concept.

                                    ShortLaboratoryTest
                                    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.

                                    Alternate NamesLaboratoriumTest
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                    184. 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.
                                    186. 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
                                    188. 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
                                    190. Observation.component.code
                                    Definition

                                    The TestCode is the name of the executed test.

                                    ShortTestCode
                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from TestCodeCodelijst
                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.3--20171231000000)

                                    LOINC (2.16.840.1.113883.6.1): All values

                                    TypeCodeableConcept
                                    Summarytrue
                                    Requirements

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

                                    Alternate NamesTestCode
                                    192. Observation.component.value[x]
                                    Definition

                                    The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

                                    ShortTestResult
                                    Comments

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

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

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

                                    Alternate NamesTestUitslag
                                    194. Observation.component.dataAbsentReason
                                    Definition

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

                                    ShortWhy the component result is missing
                                    Comments

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

                                    Control0..1
                                    This element is affected by the following invariants: obs-6
                                    BindingUnless not suitable, these codes SHALL be taken from Observation Value Absent Reason
                                    (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason|3.0.2)

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

                                    TypeCodeableConcept
                                    Requirements

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

                                    196. Observation.component.interpretation
                                    Definition

                                    Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

                                    ShortResultFlags
                                    Comments

                                    A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that maps ResultFlagsCodelist to the observation-interpretation value set.

                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from InterpretatieVlaggenCodelijst
                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

                                    InterpretatieVlaggenCodelijst

                                    TypeCodeableConcept
                                    Requirements

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

                                    Alternate NamesAbnormal Flag, InterpretatieVlaggen
                                    198. Observation.component.referenceRange
                                    Definition

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

                                    ShortProvides guide for interpretation of component result
                                    Comments

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

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

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