Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
status	S	1..1	code	registered | preliminary | final | amended +
category	SC	1..*	CodeableConcept	Classification of type of observation vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	S	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	S	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	S	1..1	dateTime, Period	Often just a dateTime for Vital Signs
performer	S	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
valueQuantity:valueQuantity	SC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
value	S	1..1	decimal	Numerical value (with implicit precision)
unit	S	1..1	string	Unit representation
system	S	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	S	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
related	S	0..*	BackboneElement	Used when reporting vital signs panel components
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SC	0..1	Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period	Vital Sign Value recorded with UCUM
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.valueQuantity:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category	SC	1..*	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (preferred): Codes for high level observation categories. vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	SΣ	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	SΣ	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Often just a dateTime for Vital Signs
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
Slices for value[x]	ΣC	0..1	Quantity	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueQuantity	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
related	SΣ	0..*	BackboneElement	Used when reporting vital signs panel components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SΣC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SΣC	0..1		Vital Sign Value recorded with UCUM
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueAttachment			Attachment
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status from the FHIR Standard
Observation.category	preferred	Observation Category Codes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.value[x]:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator from the FHIR Standard
Observation.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.related.type	required	Fixed Value: has-member http://hl7.org/fhir/ValueSet/observation-relationshiptypes from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	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()
dom-4	error	Observation	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	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()
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	Fulfills plan, proposal or order
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category	SC	1..*	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (preferred): Codes for high level observation categories. vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	SΣ	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	SΣ	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Often just a dateTime for Vital Signs
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this was made available
performer	SΣ	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for value[x]	ΣC	0..1	Quantity	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueQuantity	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
comment		0..1	string	Comments about result
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes (extensible): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
related	SΣ	0..*	BackboneElement	Used when reporting vital signs panel components
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SΣC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SΣC	0..1		Vital Sign Value recorded with UCUM
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueAttachment			Attachment
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status from the FHIR Standard
Observation.category	preferred	Observation Category Codes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.value[x]:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator from the FHIR Standard
Observation.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.interpretation	extensible	Observation Interpretation Codes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	example	SNOMED CT Body Structures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	Observation Methods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	extensible	Observation Reference Range Meaning Codes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	Observation Reference Range Applies To Codes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.related.type	required	Fixed Value: has-member http://hl7.org/fhir/ValueSet/observation-relationshiptypes from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.component.interpretation	extensible	Observation Interpretation Codes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	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()
dom-4	error	Observation	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	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()
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Summary

Mandatory: 4 elements(5 nested mandatory elements)
Must-Support: 19 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

• nl-core-patient (http://fhir.nl/fhir/StructureDefinition/nl-core-patient)
• nl-core-episodeofcare (http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare)
• HCIM Encounter (http://nictiz.nl/fhir/StructureDefinition/zib-Encounter)
• gp-Encounter (http://nictiz.nl/fhir/StructureDefinition/gp-Encounter)
• nl-core-practitioner (http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner)
• nl-core-organization (http://fhir.nl/fhir/StructureDefinition/nl-core-organization)
• nl-core-relatedperson (http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson)
• HCIM MedicalDevice Product (http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceProduct)
• VitalSigns Profile NL (http://nictiz.nl/fhir/StructureDefinition/zib-VitalSigns)

Extensions

This structure refers to these extensions:

• http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
status	S	1..1	code	registered | preliminary | final | amended +
category	SC	1..*	CodeableConcept	Classification of type of observation vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	S	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	S	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	S	1..1	dateTime, Period	Often just a dateTime for Vital Signs
performer	S	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
valueQuantity:valueQuantity	SC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
value	S	1..1	decimal	Numerical value (with implicit precision)
unit	S	1..1	string	Unit representation
system	S	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	S	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
related	S	0..*	BackboneElement	Used when reporting vital signs panel components
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SC	0..1	Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period	Vital Sign Value recorded with UCUM
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.valueQuantity:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category	SC	1..*	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (preferred): Codes for high level observation categories. vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	SΣ	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	SΣ	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Often just a dateTime for Vital Signs
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
Slices for value[x]	ΣC	0..1	Quantity	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueQuantity	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
related	SΣ	0..*	BackboneElement	Used when reporting vital signs panel components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SΣC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SΣC	0..1		Vital Sign Value recorded with UCUM
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueAttachment			Attachment
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status from the FHIR Standard
Observation.category	preferred	Observation Category Codes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.value[x]:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator from the FHIR Standard
Observation.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.related.type	required	Fixed Value: has-member http://hl7.org/fhir/ValueSet/observation-relationshiptypes from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	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()
dom-4	error	Observation	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	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()
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	nl-core-observation	FHIR Vital Signs Profile obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present vs-2: If there is no component or related element then either a value[x] or a data absent reason must be present
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	Fulfills plan, proposal or order
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category	SC	1..*	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (preferred): Codes for high level observation categories. vs-4: Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category'
code	SΣ	1..1	CodeableConcept	Coded Responses from Vital Signs Results Binding: Vital Signs (extensible): This identifies the vital sign result type.
subject	SΣ	1..1	Reference(nl-core-patient)	Who and/or what this is about
context		0..1	Reference(nl-core-episodeofcare | HCIM Encounter | gp-Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Often just a dateTime for Vital Signs
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this was made available
performer	SΣ	1..*	Reference(nl-core-practitioner | nl-core-organization | nl-core-relatedperson | nl-core-patient)	Who is responsible for the observation
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
practitionerRole		0..1	Reference(nl-core-practitionerrole)	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for value[x]	ΣC	0..1	Quantity	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueQuantity	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: Vital Signs Units (required): Common UCUM units for recording Vital Signs
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set.
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
comment		0..1	string	Comments about result
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMED CT Body Structures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(HCIM MedicalDevice Product)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: Observation Reference Range Meaning Codes (extensible): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: Observation Reference Range Applies To Codes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
related	SΣ	0..*	BackboneElement	Used when reporting vital signs panel components
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: has-member
target	S	1..1	Reference(VitalSigns Profile NL)	Resource that is related to this one
component	SΣC	0..*	BackboneElement	Component results vs-3: If there is no a value a data absent reason must be present
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: Vital Signs (extensible): This identifies the vital sign result type.
value[x]	SΣC	0..1		Vital Sign Value recorded with UCUM
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueAttachment			Attachment
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: Observation Value Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..1	CodeableConcept	High, low, normal, etc. Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status from the FHIR Standard
Observation.category	preferred	Observation Category Codes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.value[x]:valueQuantity	required	Vital Signs Units http://hl7.org/fhir/ValueSet/ucum-vitals-common from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator from the FHIR Standard
Observation.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.interpretation	extensible	Observation Interpretation Codes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	example	SNOMED CT Body Structures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	Observation Methods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	extensible	Observation Reference Range Meaning Codes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	Observation Reference Range Applies To Codes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.related.type	required	Fixed Value: has-member http://hl7.org/fhir/ValueSet/observation-relationshiptypes from the FHIR Standard
Observation.component.code	extensible	Vital Signs http://hl7.org/fhir/ValueSet/observation-vitalsignresult from the FHIR Standard
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason http://hl7.org/fhir/ValueSet/observation-valueabsentreason from the FHIR Standard
Observation.component.interpretation	extensible	Observation Interpretation Codes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	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()
dom-4	error	Observation	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	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()
vs-2	error	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value)
vs-3	error	Observation.component	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()
vs-4	error	Observation.category	Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()

Summary

Mandatory: 4 elements(5 nested mandatory elements)
Must-Support: 19 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

• nl-core-patient (http://fhir.nl/fhir/StructureDefinition/nl-core-patient)
• nl-core-episodeofcare (http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare)
• HCIM Encounter (http://nictiz.nl/fhir/StructureDefinition/zib-Encounter)
• gp-Encounter (http://nictiz.nl/fhir/StructureDefinition/gp-Encounter)
• nl-core-practitioner (http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner)
• nl-core-organization (http://fhir.nl/fhir/StructureDefinition/nl-core-organization)
• nl-core-relatedperson (http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson)
• HCIM MedicalDevice Product (http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceProduct)
• VitalSigns Profile NL (http://nictiz.nl/fhir/StructureDefinition/zib-VitalSigns)

Extensions

This structure refers to these extensions:

• http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference