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

Resource Profile: Zib Stoma - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-Stoma resource profile.

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

0. Observation
Definition

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

ShortStoma
Alternate NamesStoma
2. Observation.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
4. Observation.code
6. Observation.code.coding
SlicingThis element introduces a set of slices on Observation.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ code
  • 8. Observation.code.coding:stomaCode
    Slice NamestomaCode
    10. Observation.code.coding:stomaCode.system
    Fixed Valuehttp://snomed.info/sct
    12. Observation.code.coding:stomaCode.code
    Fixed Value245857005
    14. Observation.code.coding:stomaCode.display
    Default ValueStoma (morphologic abnormality)
    16. Observation.subject
    TypeReference(nl-core-patient)
    18. Observation.effectiveDateTime:effectiveDateTime
    Slice NameeffectiveDateTime
    Definition

    The date on which the stoma was created in the patient. A vague date, such as only the year, is permitted.

    ShortCreationDate
    TypedateTime
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Alternate NamesAanlegDatum
    20. Observation.performer
    TypeReference(nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
    22. Observation.performer.extension
    SlicingThis element introduces a set of slices on Observation.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 24. Observation.performer.extension:practitionerRole
      Slice NamepractitionerRole
      Control0..1
      TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
      26. Observation.valueCodeableConcept:valueCodeableConcept
      Slice NamevalueCodeableConcept
      Definition

      Stoma type indicates which body cavity the stoma is in and the kind of stoma used.

      ShortStoma type
      Control1..?
      BindingUnless not suitable, these codes SHALL be taken from StomaTypeCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.1--20171231000000)

      Stoma type code list

      TypeCodeableConcept
      Alternate NamesStomaType
      Example<br/><b>Zib example of double-barrelled colostomy</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "261072008", "display" : "double-barrelled colostomy" }] }
      28. Observation.comment
      Definition

      A comment on the stoma.

      ShortComment
      Alternate NamesToelichting
      30. Observation.bodySite
      Definition

      Anatomical location of the stoma on the patient.

      ShortAnatomicalLocation
      BindingUnless not suitable, these codes SHALL be taken from StomaAnatomischeLocatieCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.2--20171231000000)

      Codes describing anatomical locations for a stoma

      Alternate NamesAnatomischeLocatie
      32. Observation.bodySite.extension
      SlicingThis element introduces a set of slices on Observation.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 34. Observation.bodySite.extension:Laterality
        Slice NameLaterality
        ShortLaterality
        Control0..1
        TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
        Alternate NamesLateraliteit
        36. Observation.bodySite.extension:Laterality.valueCodeableConcept:valueCodeableConcept
        Slice NamevalueCodeableConcept
        BindingUnless not suitable, these codes SHALL be taken from StomaLateraliteitCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.3--20171231000000)

        StomaLateralityCodelist

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

        0. Observation
        Definition

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


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

        ShortStomaMeasurements and simple assertions
        Comments

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

        Control0..*
        Alternate NamesVital Signs, Measurement, Results, Tests, Stoma
        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.

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

        Allows observations to be distinguished and referenced.

        8. Observation.status
        Definition

        The status of the result value.

        Shortregistered | preliminary | final | amended +
        Comments

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

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

        Codes providing the status of an observation.

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

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

        10. Observation.code
        Definition

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

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

        Codes identifying names of simple observations.

        TypeCodeableConcept
        Summarytrue
        Requirements

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

        Alternate NamesName
        12. Observation.code.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

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

        Control0..*
        TypeCoding
        Summarytrue
        Requirements

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

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

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

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

          Control0..*
          TypeCoding
          Summarytrue
          Requirements

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

          16. Observation.code.coding:stomaCode.system
          Definition

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

          ShortIdentity of the terminology system
          Comments

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

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

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

          Fixed Valuehttp://snomed.info/sct
          18. Observation.code.coding:stomaCode.code
          Definition

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

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

          Need to refer to a particular code in the system.

          Fixed Value245857005
          20. Observation.code.coding:stomaCode.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.

          22. Observation.subject
          Definition

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

          ShortWho and/or what this is about
          Comments

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

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

          Control0..1
          TypeReference(nl-core-patient, Patient, Group, Device, Location)
          Summarytrue
          Requirements

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

          24. Observation.effective[x]
          Definition

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

          ShortClinically relevant time/time-period for observation
          Comments

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

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

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

          Alternate NamesOccurrence
          SlicingThis element introduces a set of slices on Observation.effective[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 26. Observation.effective[x]:effectiveDateTime
            Slice NameeffectiveDateTime
            Definition

            The date on which the stoma was created in the patient. A vague date, such as only the year, is permitted.


            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.

            ShortCreationDateClinically relevant time/time-period for observation
            Comments

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

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

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

            Alternate NamesOccurrence, AanlegDatum
            28. 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, Practitioner, Organization, Patient, RelatedPerson)
            Summarytrue
            Requirements

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

            30. Observation.performer.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.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 32. 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)
              34. Observation.value[x]
              Definition

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

              ShortActual result
              Comments

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

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

              Control10..1
              This element is affected by the following invariants: obs-7
              TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, Attachment, time, Range
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Summarytrue
              Requirements

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

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

                Stoma type indicates which body cavity the stoma is in and the kind of stoma used.


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

                ShortStoma typeActual result
                Comments

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

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

                Control10..1
                This element is affected by the following invariants: obs-7
                BindingUnless not suitable, these codes SHALL be taken from For codes, see StomaTypeCodelijst
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.1--20171231000000)

                Stoma type code list

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

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

                Alternate NamesStomaType
                Example<br/><b>Zib example of double-barrelled colostomy</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "261072008", "display" : "double-barrelled colostomy" }] }
                38. Observation.comment
                Definition

                A comment on the stoma.


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

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

                Need to be able to provide free text additional information.

                Alternate NamesToelichting
                40. Observation.bodySite
                Definition

                Anatomical location of the stoma on the patient.


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

                ShortAnatomicalLocationObserved 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
                BindingUnless not suitable, these codes SHALL be taken from For example codes, see StomaAnatomischeLocatieCodelijsthttp://hl7.org/fhir/ValueSet/body-site
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.2--20171231000000)

                Codes describing anatomical locations for a stoma


                Codes describing anatomical locations. May include laterality.

                TypeCodeableConcept
                Alternate NamesAnatomischeLocatie
                42. Observation.bodySite.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.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 44. Observation.bodySite.extension:Laterality
                  Slice NameLaterality
                  Definition

                  Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.

                  ShortLaterality
                  Control0..1
                  TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
                  Alternate NamesLateraliteit
                  46. Observation.bodySite.extension:Laterality.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/BodySite-Qualifier
                  48. Observation.bodySite.extension:Laterality.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
                  Control0..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] NoteSee Choice of Data Types for further information about how to use [x]
                  SlicingThis element introduces a set of slices on Observation.bodySite.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 50. Observation.bodySite.extension:Laterality.value[x]:valueCodeableConcept
                    Slice NamevalueCodeableConcept
                    Definition

                    Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.


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

                    ShortBodySite qualifierValue of extension
                    Control0..1
                    BindingUnless not suitable, these codes SHALL be taken from For codes, see StomaLateraliteitCodelijst
                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.3--20171231000000)

                    StomaLateralityCodelist

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

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

                    0. Observation
                    Definition

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

                    ShortStoma
                    Comments

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

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

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

                    ShortLogical id of this artifact
                    Comments

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

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

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

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

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

                    ShortA set of rules under which this content was created
                    Comments

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

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

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

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

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

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

                    A human language.

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

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

                    ShortText summary of the resource, for human interpretation
                    Comments

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

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

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

                    ShortContained, inline Resources
                    Comments

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

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

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

                    ShortAdditional Content defined by implementations
                    Comments

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

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

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

                    ShortExtensions that cannot be ignored
                    Comments

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

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

                    A unique identifier assigned to this observation.

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

                    Allows observations to be distinguished and referenced.

                    20. Observation.basedOn
                    Definition

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

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

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

                    Alternate NamesFulfills
                    22. Observation.status
                    Definition

                    The status of the result value.

                    Shortregistered | preliminary | final | amended +
                    Comments

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

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

                    Codes providing the status of an observation.

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

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

                    24. Observation.category
                    Definition

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

                    ShortClassification of type of observation
                    Comments

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

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

                    Codes for high level observation categories.

                    TypeCodeableConcept
                    Requirements

                    Used for filtering what observations are retrieved and displayed.

                    26. Observation.code
                    Definition

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

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

                    Codes identifying names of simple observations.

                    TypeCodeableConcept
                    Summarytrue
                    Requirements

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

                    Alternate NamesName
                    28. Observation.code.id
                    Definition

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

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

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

                    ShortAdditional Content defined by implementations
                    Comments

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

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

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..*
                      TypeCoding
                      Summarytrue
                      Requirements

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

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

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

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

                        Control0..*
                        TypeCoding
                        Summarytrue
                        Requirements

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

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

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

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

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

                        ShortAdditional Content defined by implementations
                        Comments

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

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

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

                          ShortIdentity of the terminology system
                          Comments

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

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

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

                          Fixed Valuehttp://snomed.info/sct
                          42. Observation.code.coding:stomaCode.version
                          Definition

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

                          ShortVersion of the system - if relevant
                          Comments

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

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

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

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

                          Need to refer to a particular code in the system.

                          Fixed Value245857005
                          46. Observation.code.coding:stomaCode.display
                          Definition

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

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

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

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

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

                          ShortIf this coding was chosen directly by the user
                          Comments

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

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

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

                          50. Observation.code.text
                          Definition

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

                          ShortPlain text representation of the concept
                          Comments

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

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

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

                          52. Observation.subject
                          Definition

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

                          ShortWho and/or what this is about
                          Comments

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

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

                          Control0..1
                          TypeReference(nl-core-patient)
                          Summarytrue
                          Requirements

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

                          54. Observation.context
                          Definition

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

                          ShortHealthcare event during which this observation is made
                          Comments

                          This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).

                          Control0..1
                          TypeReference(Encounter, EpisodeOfCare)
                          Requirements

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

                          Alternate NamesEncounter
                          56. Observation.effective[x]
                          Definition

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

                          ShortClinically relevant time/time-period for observation
                          Comments

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

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

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

                          Alternate NamesOccurrence
                          SlicingThis element introduces a set of slices on Observation.effective[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 58. Observation.effective[x]:effectiveDateTime
                            Slice NameeffectiveDateTime
                            Definition

                            The date on which the stoma was created in the patient. A vague date, such as only the year, is permitted.

                            ShortCreationDate
                            Comments

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

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

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

                            Alternate NamesOccurrence, AanlegDatum
                            60. Observation.issued
                            Definition

                            The date and time this observation was made available to providers, typically after the results have been reviewed and verified.

                            ShortDate/Time this was made available
                            Comments

                            Updated when the result is updated.

                            Control0..1
                            Typeinstant
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            62. Observation.performer
                            Definition

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

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

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

                            64. Observation.performer.id
                            Definition

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

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

                            An Extension

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

                              Optional Extension Element - found in all resources.

                              ShortOptional Extensions Element
                              Control0..1
                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                              70. Observation.performer.reference
                              Definition

                              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                              ShortLiteral reference, Relative, internal or absolute URL
                              Comments

                              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                              Control0..1
                              This element is affected by the following invariants: ref-1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              72. Observation.performer.identifier
                              Definition

                              An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                              ShortLogical reference, when literal reference is not known
                              Comments

                              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                              Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..1
                              TypeIdentifier
                              Summarytrue
                              74. Observation.performer.display
                              Definition

                              Plain text narrative that identifies the resource in addition to the resource reference.

                              ShortText alternative for the resource
                              Comments

                              This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              76. Observation.value[x]
                              Definition

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

                              ShortActual result
                              Comments

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

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

                              Control1..1
                              This element is affected by the following invariants: obs-7
                              TypeCodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Summarytrue
                              Requirements

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

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

                                Stoma type indicates which body cavity the stoma is in and the kind of stoma used.

                                ShortStoma type
                                Comments

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

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

                                Control1..1
                                This element is affected by the following invariants: obs-7
                                BindingUnless not suitable, these codes SHALL be taken from StomaTypeCodelijst
                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.1--20171231000000)

                                Stoma type code list

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

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

                                Alternate NamesStomaType
                                Example<br/><b>Zib example of double-barrelled colostomy</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "261072008", "display" : "double-barrelled colostomy" }] }
                                80. Observation.dataAbsentReason
                                Definition

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

                                ShortWhy the result is missing
                                Comments

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

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

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

                                TypeCodeableConcept
                                Requirements

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

                                82. Observation.interpretation
                                Definition

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

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

                                Codes identifying interpretations of observations.

                                TypeCodeableConcept
                                Requirements

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

                                Alternate NamesAbnormal Flag
                                84. Observation.comment
                                Definition

                                A comment on the stoma.

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

                                Need to be able to provide free text additional information.

                                Alternate NamesToelichting
                                86. Observation.bodySite
                                Definition

                                Anatomical location of the stoma on the patient.

                                ShortAnatomicalLocation
                                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
                                BindingUnless not suitable, these codes SHALL be taken from StomaAnatomischeLocatieCodelijst
                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.2--20171231000000)

                                Codes describing anatomical locations for a stoma

                                TypeCodeableConcept
                                Alternate NamesAnatomischeLocatie
                                88. Observation.bodySite.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.
                                90. Observation.bodySite.extension
                                Definition

                                An Extension

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

                                  Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.

                                  ShortLaterality
                                  Control0..1
                                  TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
                                  Alternate NamesLateraliteit
                                  94. Observation.bodySite.extension:Laterality.id
                                  Definition

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

                                  Shortxml:id (or equivalent in JSON)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  96. Observation.bodySite.extension:Laterality.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.bodySite.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 98. Observation.bodySite.extension:Laterality.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/BodySite-Qualifier
                                    100. Observation.bodySite.extension:Laterality.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
                                    Control0..1
                                    TypeCodeableConcept
                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                    SlicingThis element introduces a set of slices on Observation.bodySite.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 102. Observation.bodySite.extension:Laterality.value[x]:valueCodeableConcept
                                      Slice NamevalueCodeableConcept
                                      Definition

                                      Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.

                                      ShortBodySite qualifier
                                      Control0..1
                                      BindingUnless not suitable, these codes SHALL be taken from StomaLateraliteitCodelijst
                                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.5.2.3--20171231000000)

                                      StomaLateralityCodelist

                                      TypeCodeableConcept
                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                      104. Observation.bodySite.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.

                                      106. Observation.bodySite.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.

                                      108. Observation.method
                                      Definition

                                      Indicates the mechanism used to perform the observation.

                                      ShortHow it was done
                                      Comments

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

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

                                      Methods for simple observations.

                                      TypeCodeableConcept
                                      Requirements

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

                                      110. Observation.specimen
                                      Definition

                                      The specimen that was used when this observation was made.

                                      ShortSpecimen used for this observation
                                      Comments

                                      Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                                      Control0..1
                                      TypeReference(Specimen)
                                      112. Observation.device
                                      Definition

                                      The device used to generate the observation data.

                                      Short(Measurement) Device
                                      Comments

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

                                      Control0..1
                                      TypeReference(Device, DeviceMetric)
                                      114. Observation.referenceRange
                                      Definition

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

                                      ShortProvides guide for interpretation
                                      Comments

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

                                      Control0..*
                                      TypeBackboneElement
                                      Requirements

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

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                      obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                      116. 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.
                                      118. 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
                                      120. 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
                                      122. Observation.referenceRange.low
                                      Definition

                                      The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

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

                                      The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

                                      ShortHigh Range, if relevant
                                      Control0..1
                                      This element is affected by the following invariants: obs-3
                                      TypeQuantity(SimpleQuantity)
                                      126. Observation.referenceRange.type
                                      Definition

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

                                      ShortReference range qualifier
                                      Comments

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

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

                                      Code for the meaning of a reference range.

                                      TypeCodeableConcept
                                      Requirements

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

                                      128. Observation.referenceRange.appliesTo
                                      Definition

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

                                      ShortReference range population
                                      Comments

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

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

                                      Codes identifying the population the reference range applies to.

                                      TypeCodeableConcept
                                      Requirements

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

                                      130. 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.

                                      132. 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
                                      134. Observation.related
                                      Definition

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

                                      ShortResource related to this observation
                                      Comments

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

                                      Control0..*
                                      TypeBackboneElement
                                      Summarytrue
                                      Requirements

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

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                      136. 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.
                                      138. 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
                                      140. 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
                                      142. Observation.related.type
                                      Definition

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

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

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

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

                                      Codes specifying how two observations are related.

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

                                      A relationship type SHOULD be provided.

                                      144. Observation.related.target
                                      Definition

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

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

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

                                      ShortComponent results
                                      Comments

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

                                      Control0..*
                                      TypeBackboneElement
                                      Summarytrue
                                      Requirements

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

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                      148. 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.
                                      150. 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
                                      152. 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
                                      154. Observation.component.code
                                      Definition

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

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

                                      Codes identifying names of simple observations.

                                      TypeCodeableConcept
                                      Summarytrue
                                      Requirements

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

                                      156. Observation.component.value[x]
                                      Definition

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

                                      ShortActual component result
                                      Comments

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

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

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

                                      158. Observation.component.dataAbsentReason
                                      Definition

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

                                      ShortWhy the component result is missing
                                      Comments

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

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

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

                                      TypeCodeableConcept
                                      Requirements

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

                                      160. Observation.component.interpretation
                                      Definition

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

                                      ShortHigh, low, normal, etc.
                                      Comments

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

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

                                      Codes identifying interpretations of observations.

                                      TypeCodeableConcept
                                      Requirements

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

                                      Alternate NamesAbnormal Flag
                                      162. Observation.component.referenceRange
                                      Definition

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

                                      ShortProvides guide for interpretation of component result
                                      Comments

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

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

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