AU Core Implementation Guide
0.4.0-preview - Preview Australia flag

This page is part of the AU Core (v0.4.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: AUCoreRespirationRate - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the au-core-resprate resource profile.

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

0. Observation
Definition

Measurement of a patient's respiration rate at a point in time.

ShortRespiration rate
Comments

Respiration rate observation using a LOINC code and a SNOMED CT code.

Invariantsau-core-obs-02: At least value or data absent reason shall be present (dataAbsentReason.exists() or value.exists())
2. Observation.status
Obligations
    ObligationsActor
    SHALL:populate-if-knownAU Core Responder
    SHALL:no-errorAU Core Requester
    4. Observation.category
    Obligations
      ObligationsActor
      SHALL:populate-if-knownAU Core Responder
      SHALL:no-errorAU Core Requester
      6. Observation.category:VSCat
      Slice NameVSCat
      Obligations
        ObligationsActor
        SHALL:populate-if-knownAU Core Responder
        SHALL:no-errorAU Core Requester
        8. Observation.category:VSCat.coding
        Obligations
          ObligationsActor
          SHALL:populate-if-knownAU Core Responder
          SHALL:no-errorAU Core Requester
          10. Observation.category:VSCat.coding.system
          Obligations
            ObligationsActor
            SHALL:populate-if-knownAU Core Responder
            SHALL:no-errorAU Core Requester
            12. Observation.category:VSCat.coding.code
            Obligations
              ObligationsActor
              SHALL:populate-if-knownAU Core Responder
              SHALL:no-errorAU Core Requester
              14. Observation.code
              Obligations
                ObligationsActor
                SHALL:populate-if-knownAU Core Responder
                SHALL:no-errorAU Core Requester
                16. Observation.code.coding
                Control2..?
                18. Observation.code.coding:snomedRespRateCode
                Slice NamesnomedRespRateCode
                ShortSNOMED CT Respiration Rate
                Control1..1
                20. Observation.code.coding:snomedRespRateCode.system
                Control1..?
                Fixed Valuehttp://snomed.info/sct
                22. Observation.code.coding:snomedRespRateCode.code
                Control1..?
                Fixed Value86290005
                24. Observation.subject
                TypeReference(AU Core Patient)
                Obligations
                  ObligationsActor
                  SHALL:populate-if-knownAU Core Responder
                  SHALL:no-errorAU Core Requester
                  26. Observation.effective[x]
                  Definition

                  Date, and optionally time, the observation was performed.

                  ShortDate, and optionally time, the observation was performed
                  TypedateTime, Period
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Obligations
                    ObligationsActor
                    SHALL:populate-if-knownAU Core Responder
                    SHALL:no-errorAU Core Requester
                    Invariantsau-core-obs-01: Date shall be at least to day ($this is DateTime implies $this.toString().length() >= 10)
                    28. Observation.valueQuantity
                    ShortRespiration rate
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownAU Core Responder
                      SHALL:no-errorAU Core Requester
                      30. Observation.valueQuantity.value
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownAU Core Responder
                        SHALL:no-errorAU Core Requester
                        32. Observation.valueQuantity.unit
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownAU Core Responder
                          SHALL:no-errorAU Core Requester
                          34. Observation.valueQuantity.system
                          Obligations
                            ObligationsActor
                            SHALL:populate-if-knownAU Core Responder
                            SHALL:no-errorAU Core Requester
                            36. Observation.valueQuantity.code
                            Obligations
                              ObligationsActor
                              SHALL:populate-if-knownAU Core Responder
                              SHALL:no-errorAU Core Requester
                              38. Observation.dataAbsentReason
                              Obligations
                                ObligationsActor
                                SHALL:populate-if-knownAU Core Responder
                                SHALL:no-errorAU Core Requester
                                40. Observation.bodySite
                                BindingThe codes SHOULD be taken from Body Site .
                                (preferred to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                                Invariantsau-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
                                42. Observation.component
                                Obligations
                                  ObligationsActor
                                  SHALL:populate-if-knownAU Core Responder
                                  SHALL:no-errorAU Core Requester
                                  44. Observation.component.code
                                  Obligations
                                    ObligationsActor
                                    SHALL:populate-if-knownAU Core Responder
                                    SHALL:no-errorAU Core Requester
                                    46. Observation.component.value[x]
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Obligations
                                      ObligationsActor
                                      SHALL:populate-if-knownAU Core Responder
                                      SHALL:no-errorAU Core Requester
                                      48. Observation.component.dataAbsentReason
                                      Obligations
                                        ObligationsActor
                                        SHALL:populate-if-knownAU Core Responder
                                        SHALL:no-errorAU Core Requester

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

                                        0. Observation
                                        Definition

                                        Measurement of a patient's respiration rate at a point in time.


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

                                        ShortRespiration rateMeasurements and simple assertions
                                        Comments

                                        Respiration rate observation using a LOINC code and a SNOMED CT code.


                                        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 laboratory reports, etc.

                                        Control0..*
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate NamesVital Signs, Measurement, Results, Tests
                                        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                        dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                        obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                        obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
                                        vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present. ((component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists()))
                                        au-core-obs-02: At least value or data absent reason shall be present (dataAbsentReason.exists() or value.exists())
                                        obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                        obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                        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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                        Control0..1
                                        Typeuri
                                        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                        Summaryfalse
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        6. Observation.status
                                        Definition

                                        The status of the result value.

                                        Shortregistered | preliminary | final | amended +
                                        Comments

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

                                        Control1..1
                                        BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|4.0.1
                                        (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)
                                        Typecode
                                        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Obligations
                                          ObligationsActor
                                          SHALL:populate-if-knownAU Core Responder
                                          SHALL:no-errorAU Core Requester
                                          Summarytrue
                                          Requirements

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

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          8. Observation.category
                                          Definition

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

                                          ShortClassification of type of observation
                                          Comments

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

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

                                          Codes for high level observation categories.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Obligations
                                            ObligationsActor
                                            SHALL:populate-if-knownAU Core Responder
                                            SHALL:no-errorAU Core Requester
                                            Summaryfalse
                                            Requirements

                                            Used for filtering what observations are retrieved and displayed.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ coding.code
                                            • value @ coding.system
                                            • 10. Observation.category:VSCat
                                              Slice NameVSCat
                                              Definition

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

                                              ShortClassification of type of observation
                                              Comments

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

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

                                              Codes for high level observation categories.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Obligations
                                                ObligationsActor
                                                SHALL:populate-if-knownAU Core Responder
                                                SHALL:no-errorAU Core Requester
                                                Summaryfalse
                                                Requirements

                                                Used for filtering what observations are retrieved and displayed.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                12. Observation.category:VSCat.coding
                                                Definition

                                                A reference to a code defined by a terminology system.

                                                ShortCode defined by a terminology system
                                                Comments

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

                                                Control10..*
                                                TypeCoding
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Obligations
                                                  ObligationsActor
                                                  SHALL:populate-if-knownAU Core Responder
                                                  SHALL:no-errorAU Core Requester
                                                  Summarytrue
                                                  Requirements

                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  14. Observation.category:VSCat.coding.system
                                                  Definition

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

                                                  ShortIdentity of the terminology system
                                                  Comments

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

                                                  Control10..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Obligations
                                                    ObligationsActor
                                                    SHALL:populate-if-knownAU Core Responder
                                                    SHALL:no-errorAU Core Requester
                                                    Summarytrue
                                                    Requirements

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

                                                    Fixed Valuehttp://terminology.hl7.org/CodeSystem/observation-category
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    16. Observation.category:VSCat.coding.code
                                                    Definition

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

                                                    ShortSymbol in syntax defined by the system
                                                    Control10..1
                                                    Typecode
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Obligations
                                                      ObligationsActor
                                                      SHALL:populate-if-knownAU Core Responder
                                                      SHALL:no-errorAU Core Requester
                                                      Summarytrue
                                                      Requirements

                                                      Need to refer to a particular code in the system.

                                                      Fixed Valuevital-signs
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      18. Observation.code
                                                      Definition

                                                      Respiratory Rate.


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

                                                      ShortRespiratory RateType of observation (code / type)
                                                      Comments

                                                      additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.


                                                      All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                      Control1..1
                                                      BindingUnless not suitable, these codes SHALL be taken from For example codes, see VitalSignshttp://hl7.org/fhir/ValueSet/observation-codes
                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                      This identifies the vital sign result type.


                                                      Codes identifying names of simple observations.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Obligations
                                                        ObligationsActor
                                                        SHALL:populate-if-knownAU Core Responder
                                                        SHALL:no-errorAU Core Requester
                                                        Summarytrue
                                                        Requirements
                                                        1. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).

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

                                                        Alternate NamesName, Test
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        20. 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.

                                                        Control20..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ code
                                                        • value @ system
                                                        • 22. Observation.code.coding:RespRateCode
                                                          Slice NameRespRateCode
                                                          Definition

                                                          A reference to a code defined by a terminology system.

                                                          ShortCode defined by a terminology system
                                                          Comments

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

                                                          Control10..1*
                                                          TypeCoding
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          Requirements

                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          24. Observation.code.coding:RespRateCode.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 reference to some definition that establishes the system clearly and unambiguously.

                                                          Control10..1
                                                          Typeuri
                                                          Is Modifierfalse
                                                          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://loinc.org
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          26. Observation.code.coding:RespRateCode.code
                                                          Definition

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

                                                          ShortSymbol in syntax defined by the system
                                                          Control10..1
                                                          Typecode
                                                          Is Modifierfalse
                                                          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 Value9279-1
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          28. Observation.code.coding:snomedRespRateCode
                                                          Slice NamesnomedRespRateCode
                                                          Definition

                                                          A reference to a code defined by a terminology system.

                                                          ShortSNOMED CT Respiration RateCode defined by a terminology system
                                                          Comments

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

                                                          Control10..1*
                                                          TypeCoding
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          Requirements

                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          30. Observation.code.coding:snomedRespRateCode.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 reference to some definition that establishes the system clearly and unambiguously.

                                                          Control10..1
                                                          Typeuri
                                                          Is Modifierfalse
                                                          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
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          32. Observation.code.coding:snomedRespRateCode.code
                                                          Definition

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

                                                          ShortSymbol in syntax defined by the system
                                                          Control10..1
                                                          Typecode
                                                          Is Modifierfalse
                                                          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 Value86290005
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          34. Observation.subject
                                                          Definition

                                                          The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

                                                          ShortWho and/or what the observation 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.

                                                          Control10..1
                                                          TypeReference(AU Core Patient, Patient, Group, Device, Location)
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Obligations
                                                            ObligationsActor
                                                            SHALL:populate-if-knownAU Core Responder
                                                            SHALL:no-errorAU Core Requester
                                                            Summarytrue
                                                            Requirements

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

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            36. Observation.effective[x]
                                                            Definition

                                                            Date, and optionally time, the observation was performed.


                                                            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.

                                                            ShortDate, and optionally time, the observation was performedClinically relevant time/time-period for observation
                                                            Comments

                                                            At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.


                                                            At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                                            Control10..1
                                                            This element is affected by the following invariants: vs-1, au-core-obs-01
                                                            TypedateTime, Period, Timing, instant
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Obligations
                                                              ObligationsActor
                                                              SHALL:populate-if-knownAU Core Responder
                                                              SHALL:no-errorAU Core Requester
                                                              Summarytrue
                                                              Requirements

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

                                                              Alternate NamesOccurrence
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day ($this is dateTime implies $this.toString().length() >= 10)
                                                              au-core-obs-01: Date shall be at least to day ($this is DateTime implies $this.toString().length() >= 10)
                                                              38. Observation.value[x]
                                                              Definition

                                                              Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.


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

                                                              ShortVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.Actual result
                                                              Comments

                                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.


                                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.

                                                              Control0..1
                                                              This element is affected by the following invariants: obs-7, vs-2
                                                              TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements
                                                              1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                              • type @ $this
                                                              • 40. Observation.value[x]:valueQuantity
                                                                Slice NamevalueQuantity
                                                                Definition

                                                                Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.


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

                                                                ShortRespiration rateActual result
                                                                Comments

                                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.


                                                                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.

                                                                Control0..1
                                                                This element is affected by the following invariants: obs-7, vs-2, au-core-obs-02
                                                                TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Obligations
                                                                  ObligationsActor
                                                                  SHALL:populate-if-knownAU Core Responder
                                                                  SHALL:no-errorAU Core Requester
                                                                  Summarytrue
                                                                  Requirements
                                                                  1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

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

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  42. Observation.value[x]:valueQuantity.value
                                                                  Definition

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

                                                                  ShortNumerical value (with implicit precision)
                                                                  Comments

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

                                                                  Control10..1
                                                                  Typedecimal
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Obligations
                                                                    ObligationsActor
                                                                    SHALL:populate-if-knownAU Core Responder
                                                                    SHALL:no-errorAU Core Requester
                                                                    Summarytrue
                                                                    Requirements

                                                                    Precision is handled implicitly in almost all cases of measurement.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    44. Observation.value[x]:valueQuantity.comparator
                                                                    Definition

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

                                                                    Short< | <= | >= | > - how to understand the value
                                                                    Control0..1
                                                                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                                                                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                    How the Quantity should be understood and represented.

                                                                    Typecode
                                                                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

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

                                                                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    46. Observation.value[x]:valueQuantity.unit
                                                                    Definition

                                                                    A human-readable form of the unit.

                                                                    ShortUnit representation
                                                                    Control10..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Must Supporttrue
                                                                    Obligations
                                                                      ObligationsActor
                                                                      SHALL:populate-if-knownAU Core Responder
                                                                      SHALL:no-errorAU Core Requester
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      48. Observation.value[x]:valueQuantity.system
                                                                      Definition

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

                                                                      ShortSystem that defines coded unit form
                                                                      Control10..1
                                                                      This element is affected by the following invariants: qty-3
                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Obligations
                                                                        ObligationsActor
                                                                        SHALL:populate-if-knownAU Core Responder
                                                                        SHALL:no-errorAU Core Requester
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Fixed Valuehttp://unitsofmeasure.org
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        50. Observation.value[x]:valueQuantity.code
                                                                        Definition

                                                                        Coded responses from the common UCUM units for vital signs value set.


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

                                                                        ShortCoded responses from the common UCUM units for vital signs value set.Coded form of the unit
                                                                        Comments

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

                                                                        Control10..1
                                                                        Typecode
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Obligations
                                                                          ObligationsActor
                                                                          SHALL:populate-if-knownAU Core Responder
                                                                          SHALL:no-errorAU Core Requester
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          Fixed Value/min
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          52. 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, vs-2, au-core-obs-02
                                                                          BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                                                                          (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

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

                                                                          TypeCodeableConcept
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Obligations
                                                                            ObligationsActor
                                                                            SHALL:populate-if-knownAU Core Responder
                                                                            SHALL:no-errorAU Core Requester
                                                                            Summaryfalse
                                                                            Requirements

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

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

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

                                                                            ShortObserved body part
                                                                            Comments

                                                                            Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                                            If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.


                                                                            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 bodySite.

                                                                            Control0..1
                                                                            This element is affected by the following invariants: au-core-obs-04
                                                                            BindingThe codes SHOULD be taken from For example codes, see Body Site .http://hl7.org/fhir/ValueSet/body-site
                                                                            (preferred to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                                                                            TypeCodeableConcept
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
                                                                            56. Observation.component
                                                                            Definition

                                                                            Used when reporting systolic and diastolic blood pressure.


                                                                            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.

                                                                            ShortUsed when reporting systolic and diastolic blood pressure.Component results
                                                                            Comments

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


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

                                                                            Control0..*
                                                                            TypeBackboneElement
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Obligations
                                                                              ObligationsActor
                                                                              SHALL:populate-if-knownAU Core Responder
                                                                              SHALL:no-errorAU Core Requester
                                                                              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() or (children().count() > id.count()))
                                                                              vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                                                              58. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.

                                                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                              ShortExtensions that cannot be ignored even if unrecognized
                                                                              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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                              Summarytrue
                                                                              Requirements

                                                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                                                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                              Alternate Namesextensions, user content, modifiers
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              60. Observation.component.code
                                                                              Definition

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

                                                                              ShortType of component observation (code / type)
                                                                              Comments

                                                                              All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                              Control1..1
                                                                              BindingUnless not suitable, these codes SHALL be taken from For example codes, see VitalSignshttp://hl7.org/fhir/ValueSet/observation-codes
                                                                              (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                                              This identifies the vital sign result type.


                                                                              Codes identifying names of simple observations.

                                                                              TypeCodeableConcept
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Obligations
                                                                                ObligationsActor
                                                                                SHALL:populate-if-knownAU Core Responder
                                                                                SHALL:no-errorAU Core Requester
                                                                                Summarytrue
                                                                                Requirements

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

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                62. Observation.component.value[x]
                                                                                Definition

                                                                                Vital Sign Value recorded with UCUM.


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

                                                                                ShortVital Sign Value recorded with UCUMActual component result
                                                                                Comments

                                                                                Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was 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 additional guidance, see the Notes section below.


                                                                                Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was 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 additional guidance, see the Notes section below.

                                                                                Control0..1
                                                                                This element is affected by the following invariants: vs-3
                                                                                BindingUnless not suitable, these codes SHALL be taken from For codes, see VitalSignsUnits
                                                                                (extensible to http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1)

                                                                                Common UCUM units for recording Vital Signs.

                                                                                TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                Is Modifierfalse
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                Must Supporttrue
                                                                                Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                Obligations
                                                                                  ObligationsActor
                                                                                  SHALL:populate-if-knownAU Core Responder
                                                                                  SHALL:no-errorAU Core Requester
                                                                                  Summarytrue
                                                                                  Requirements
                                                                                  1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).

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

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

                                                                                  Provides a reason why the expected value in the element Observation.component.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, vs-3
                                                                                  BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

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

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Obligations
                                                                                    ObligationsActor
                                                                                    SHALL:populate-if-knownAU Core Responder
                                                                                    SHALL:no-errorAU Core Requester
                                                                                    Summaryfalse
                                                                                    Requirements

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

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                                                                                    0. Observation
                                                                                    Definition

                                                                                    Measurement of a patient's respiration rate at a point in time.

                                                                                    ShortRespiration rate
                                                                                    Comments

                                                                                    Respiration rate observation using a LOINC code and a SNOMED CT code.

                                                                                    Control0..*
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate NamesVital Signs, Measurement, Results, Tests
                                                                                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                                                                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                                                                    dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                                                                    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                                                                    obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty())
                                                                                    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present. ((component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists()))
                                                                                    au-core-obs-02: At least value or data absent reason shall be present (dataAbsentReason.exists() or value.exists())
                                                                                    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
                                                                                    Is Modifierfalse
                                                                                    Summarytrue
                                                                                    4. Observation.meta
                                                                                    Definition

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

                                                                                    ShortMetadata about the resource
                                                                                    Control0..1
                                                                                    TypeMeta
                                                                                    Is Modifierfalse
                                                                                    Summarytrue
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                                                                    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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                                                                    Control0..1
                                                                                    Typeuri
                                                                                    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summarytrue
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    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
                                                                                    BindingThe codes SHOULD be taken from CommonLanguages
                                                                                    (preferred to http://hl7.org/fhir/ValueSet/languages)

                                                                                    A human language.

                                                                                    Additional BindingsPurpose
                                                                                    AllLanguagesMax Binding
                                                                                    Typecode
                                                                                    Is Modifierfalse
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Summaryfalse
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    10. Observation.text
                                                                                    Definition

                                                                                    A human-readable narrative that contains a summary of the resource and can 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 information is added later.

                                                                                    Control0..1
                                                                                    TypeNarrative
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesnarrative, html, xhtml, display
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                                                                                    Control0..*
                                                                                    TypeResource
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    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. 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 can 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
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesextensions, user content
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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.

                                                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                    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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                                                                    Summaryfalse
                                                                                    Requirements

                                                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                    Alternate Namesextensions, user content
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    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
                                                                                    Is Modifierfalse
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Allows observations to be distinguished and referenced.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    20. Observation.basedOn
                                                                                    Definition

                                                                                    A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

                                                                                    ShortFulfills plan, proposal or order
                                                                                    Control0..*
                                                                                    TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
                                                                                    Is Modifierfalse
                                                                                    Summarytrue
                                                                                    Requirements

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

                                                                                    Alternate NamesFulfills
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    22. Observation.partOf
                                                                                    Definition

                                                                                    A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

                                                                                    ShortPart of referenced event
                                                                                    Comments

                                                                                    To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

                                                                                    Control0..*
                                                                                    TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Immunization, ImagingStudy)
                                                                                    Is Modifierfalse
                                                                                    Summarytrue
                                                                                    Alternate NamesContainer
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    24. Observation.status
                                                                                    Definition

                                                                                    The status of the result value.

                                                                                    Shortregistered | preliminary | final | amended +
                                                                                    Comments

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

                                                                                    Control1..1
                                                                                    BindingThe codes SHALL be taken from ObservationStatus
                                                                                    (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)
                                                                                    Typecode
                                                                                    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                    Must Supporttrue
                                                                                    Obligations
                                                                                      ObligationsActor
                                                                                      SHALL:populate-if-knownAU Core Responder
                                                                                      SHALL:no-errorAU Core Requester
                                                                                      Summarytrue
                                                                                      Requirements

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

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      26. Observation.category
                                                                                      Definition

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

                                                                                      ShortClassification of type of observation
                                                                                      Comments

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

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

                                                                                      Codes for high level observation categories.

                                                                                      TypeCodeableConcept
                                                                                      Is Modifierfalse
                                                                                      Must Supporttrue
                                                                                      Obligations
                                                                                        ObligationsActor
                                                                                        SHALL:populate-if-knownAU Core Responder
                                                                                        SHALL:no-errorAU Core Requester
                                                                                        Summaryfalse
                                                                                        Requirements

                                                                                        Used for filtering what observations are retrieved and displayed.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • value @ coding.code
                                                                                        • value @ coding.system
                                                                                        • 28. Observation.category:VSCat
                                                                                          Slice NameVSCat
                                                                                          Definition

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

                                                                                          ShortClassification of type of observation
                                                                                          Comments

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

                                                                                          Control1..1
                                                                                          BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                                                          (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                                                                                          Codes for high level observation categories.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Obligations
                                                                                            ObligationsActor
                                                                                            SHALL:populate-if-knownAU Core Responder
                                                                                            SHALL:no-errorAU Core Requester
                                                                                            Summaryfalse
                                                                                            Requirements

                                                                                            Used for filtering what observations are retrieved and displayed.

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            30. Observation.category:VSCat.id
                                                                                            Definition

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

                                                                                            ShortUnique id for inter-element referencing
                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Summaryfalse
                                                                                            32. Observation.category:VSCat.extension
                                                                                            Definition

                                                                                            May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                            Is Modifierfalse
                                                                                            Summaryfalse
                                                                                            Alternate Namesextensions, user content
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                            SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                            • value @ url
                                                                                            • 34. Observation.category:VSCat.coding
                                                                                              Definition

                                                                                              A reference to a code defined by a terminology system.

                                                                                              ShortCode defined by a terminology system
                                                                                              Comments

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

                                                                                              Control1..*
                                                                                              TypeCoding
                                                                                              Is Modifierfalse
                                                                                              Must Supporttrue
                                                                                              Obligations
                                                                                                ObligationsActor
                                                                                                SHALL:populate-if-knownAU Core Responder
                                                                                                SHALL:no-errorAU Core Requester
                                                                                                Summarytrue
                                                                                                Requirements

                                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                36. Observation.category:VSCat.coding.id
                                                                                                Definition

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

                                                                                                ShortUnique id for inter-element referencing
                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Is Modifierfalse
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                Summaryfalse
                                                                                                38. Observation.category:VSCat.coding.extension
                                                                                                Definition

                                                                                                May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                Is Modifierfalse
                                                                                                Summaryfalse
                                                                                                Alternate Namesextensions, user content
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • value @ url
                                                                                                • 40. Observation.category:VSCat.coding.system
                                                                                                  Definition

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

                                                                                                  ShortIdentity of the terminology system
                                                                                                  Comments

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

                                                                                                  Control1..1
                                                                                                  Typeuri
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  Obligations
                                                                                                    ObligationsActor
                                                                                                    SHALL:populate-if-knownAU Core Responder
                                                                                                    SHALL:no-errorAU Core Requester
                                                                                                    Summarytrue
                                                                                                    Requirements

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

                                                                                                    Fixed Valuehttp://terminology.hl7.org/CodeSystem/observation-category
                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    42. Observation.category:VSCat.coding.version
                                                                                                    Definition

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

                                                                                                    ShortVersion of the system - if relevant
                                                                                                    Comments

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

                                                                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                    Control0..1
                                                                                                    Typestring
                                                                                                    Is Modifierfalse
                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                    Summarytrue
                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                    44. Observation.category:VSCat.coding.code
                                                                                                    Definition

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

                                                                                                    ShortSymbol in syntax defined by the system
                                                                                                    Control1..1
                                                                                                    Typecode
                                                                                                    Is Modifierfalse
                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                    Must Supporttrue
                                                                                                    Obligations
                                                                                                      ObligationsActor
                                                                                                      SHALL:populate-if-knownAU Core Responder
                                                                                                      SHALL:no-errorAU Core Requester
                                                                                                      Summarytrue
                                                                                                      Requirements

                                                                                                      Need to refer to a particular code in the system.

                                                                                                      Fixed Valuevital-signs
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      46. Observation.category:VSCat.coding.display
                                                                                                      Definition

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

                                                                                                      ShortRepresentation defined by the system
                                                                                                      Control0..1
                                                                                                      Typestring
                                                                                                      Is Modifierfalse
                                                                                                      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.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      48. Observation.category:VSCat.coding.userSelected
                                                                                                      Definition

                                                                                                      Indicates that this coding was chosen by a user directly - e.g. 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
                                                                                                      Is Modifierfalse
                                                                                                      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.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      50. Observation.category:VSCat.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
                                                                                                      Is Modifierfalse
                                                                                                      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.

                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      52. Observation.code
                                                                                                      Definition

                                                                                                      Respiratory Rate.

                                                                                                      ShortRespiratory Rate
                                                                                                      Comments

                                                                                                      additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.

                                                                                                      Control1..1
                                                                                                      BindingUnless not suitable, these codes SHALL be taken from VitalSigns
                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                                                                      This identifies the vital sign result type.

                                                                                                      TypeCodeableConcept
                                                                                                      Is Modifierfalse
                                                                                                      Must Supporttrue
                                                                                                      Obligations
                                                                                                        ObligationsActor
                                                                                                        SHALL:populate-if-knownAU Core Responder
                                                                                                        SHALL:no-errorAU Core Requester
                                                                                                        Summarytrue
                                                                                                        Requirements
                                                                                                        1. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
                                                                                                        Alternate NamesName, Test
                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                        54. 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.

                                                                                                        ShortUnique id for inter-element referencing
                                                                                                        Control0..1
                                                                                                        Typestring
                                                                                                        Is Modifierfalse
                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                        Summaryfalse
                                                                                                        56. Observation.code.extension
                                                                                                        Definition

                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                        Is Modifierfalse
                                                                                                        Summaryfalse
                                                                                                        Alternate Namesextensions, user content
                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                        SlicingThis element introduces a set of slices on Observation.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                        • value @ url
                                                                                                        • 58. 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.

                                                                                                          Control2..*
                                                                                                          TypeCoding
                                                                                                          Is Modifierfalse
                                                                                                          Summarytrue
                                                                                                          Requirements

                                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                          • value @ code
                                                                                                          • value @ system
                                                                                                          • 60. Observation.code.coding:RespRateCode
                                                                                                            Slice NameRespRateCode
                                                                                                            Definition

                                                                                                            A reference to a code defined by a terminology system.

                                                                                                            ShortCode defined by a terminology system
                                                                                                            Comments

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

                                                                                                            Control1..1
                                                                                                            TypeCoding
                                                                                                            Is Modifierfalse
                                                                                                            Summarytrue
                                                                                                            Requirements

                                                                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            62. Observation.code.coding:RespRateCode.id
                                                                                                            Definition

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

                                                                                                            ShortUnique id for inter-element referencing
                                                                                                            Control0..1
                                                                                                            Typestring
                                                                                                            Is Modifierfalse
                                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                            Summaryfalse
                                                                                                            64. Observation.code.coding:RespRateCode.extension
                                                                                                            Definition

                                                                                                            May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                            Is Modifierfalse
                                                                                                            Summaryfalse
                                                                                                            Alternate Namesextensions, user content
                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                            SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                            • value @ url
                                                                                                            • 66. Observation.code.coding:RespRateCode.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 reference to some definition that establishes the system clearly and unambiguously.

                                                                                                              Control1..1
                                                                                                              Typeuri
                                                                                                              Is Modifierfalse
                                                                                                              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://loinc.org
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              68. Observation.code.coding:RespRateCode.version
                                                                                                              Definition

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

                                                                                                              ShortVersion of the system - if relevant
                                                                                                              Comments

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

                                                                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                              Summarytrue
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              70. Observation.code.coding:RespRateCode.code
                                                                                                              Definition

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

                                                                                                              ShortSymbol in syntax defined by the system
                                                                                                              Control1..1
                                                                                                              Typecode
                                                                                                              Is Modifierfalse
                                                                                                              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 Value9279-1
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              72. Observation.code.coding:RespRateCode.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
                                                                                                              Is Modifierfalse
                                                                                                              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.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              74. Observation.code.coding:RespRateCode.userSelected
                                                                                                              Definition

                                                                                                              Indicates that this coding was chosen by a user directly - e.g. 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
                                                                                                              Is Modifierfalse
                                                                                                              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.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              76. Observation.code.coding:snomedRespRateCode
                                                                                                              Slice NamesnomedRespRateCode
                                                                                                              Definition

                                                                                                              A reference to a code defined by a terminology system.

                                                                                                              ShortSNOMED CT Respiration Rate
                                                                                                              Comments

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

                                                                                                              Control1..1
                                                                                                              TypeCoding
                                                                                                              Is Modifierfalse
                                                                                                              Summarytrue
                                                                                                              Requirements

                                                                                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              78. Observation.code.coding:snomedRespRateCode.id
                                                                                                              Definition

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

                                                                                                              ShortUnique id for inter-element referencing
                                                                                                              Control0..1
                                                                                                              Typestring
                                                                                                              Is Modifierfalse
                                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                              Summaryfalse
                                                                                                              80. Observation.code.coding:snomedRespRateCode.extension
                                                                                                              Definition

                                                                                                              May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                              Is Modifierfalse
                                                                                                              Summaryfalse
                                                                                                              Alternate Namesextensions, user content
                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                              SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                              • value @ url
                                                                                                              • 82. Observation.code.coding:snomedRespRateCode.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 reference to some definition that establishes the system clearly and unambiguously.

                                                                                                                Control1..1
                                                                                                                Typeuri
                                                                                                                Is Modifierfalse
                                                                                                                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
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                84. Observation.code.coding:snomedRespRateCode.version
                                                                                                                Definition

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

                                                                                                                ShortVersion of the system - if relevant
                                                                                                                Comments

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

                                                                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                                                Control0..1
                                                                                                                Typestring
                                                                                                                Is Modifierfalse
                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                Summarytrue
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                86. Observation.code.coding:snomedRespRateCode.code
                                                                                                                Definition

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

                                                                                                                ShortSymbol in syntax defined by the system
                                                                                                                Control1..1
                                                                                                                Typecode
                                                                                                                Is Modifierfalse
                                                                                                                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 Value86290005
                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                88. Observation.code.coding:snomedRespRateCode.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
                                                                                                                Is Modifierfalse
                                                                                                                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.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                90. Observation.code.coding:snomedRespRateCode.userSelected
                                                                                                                Definition

                                                                                                                Indicates that this coding was chosen by a user directly - e.g. 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
                                                                                                                Is Modifierfalse
                                                                                                                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.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                92. 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
                                                                                                                Is Modifierfalse
                                                                                                                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.

                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                94. Observation.subject
                                                                                                                Definition

                                                                                                                The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

                                                                                                                ShortWho and/or what the observation 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.

                                                                                                                Control1..1
                                                                                                                TypeReference(AU Core Patient)
                                                                                                                Is Modifierfalse
                                                                                                                Must Supporttrue
                                                                                                                Obligations
                                                                                                                  ObligationsActor
                                                                                                                  SHALL:populate-if-knownAU Core Responder
                                                                                                                  SHALL:no-errorAU Core Requester
                                                                                                                  Summarytrue
                                                                                                                  Requirements

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

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

                                                                                                                  The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

                                                                                                                  ShortWhat the observation is about, when it is not about the subject of record
                                                                                                                  Comments

                                                                                                                  Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

                                                                                                                  Control0..*
                                                                                                                  TypeReference(Resource)
                                                                                                                  Is Modifierfalse
                                                                                                                  Summarytrue
                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  98. Observation.encounter
                                                                                                                  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 but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                                                                                                                  Control0..1
                                                                                                                  TypeReference(Encounter)
                                                                                                                  Is Modifierfalse
                                                                                                                  Summarytrue
                                                                                                                  Requirements

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

                                                                                                                  Alternate NamesContext
                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                  100. Observation.effective[x]
                                                                                                                  Definition

                                                                                                                  Date, and optionally time, the observation was performed.

                                                                                                                  ShortDate, and optionally time, the observation was performed
                                                                                                                  Comments

                                                                                                                  At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                                                                                                  Control1..1
                                                                                                                  This element is affected by the following invariants: vs-1, au-core-obs-01
                                                                                                                  TypedateTime
                                                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                  Is Modifierfalse
                                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                  Must Supporttrue
                                                                                                                  Obligations
                                                                                                                    ObligationsActor
                                                                                                                    SHALL:populate-if-knownAU Core Responder
                                                                                                                    SHALL:no-errorAU Core Requester
                                                                                                                    Summarytrue
                                                                                                                    Requirements

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

                                                                                                                    Alternate NamesOccurrence
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day ($this is dateTime implies $this.toString().length() >= 10)
                                                                                                                    au-core-obs-01: Date shall be at least to day ($this is DateTime implies $this.toString().length() >= 10)
                                                                                                                    102. Observation.issued
                                                                                                                    Definition

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

                                                                                                                    ShortDate/Time this version was made available
                                                                                                                    Comments

                                                                                                                    For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

                                                                                                                    Control0..1
                                                                                                                    Typeinstant
                                                                                                                    Is Modifierfalse
                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                    Summarytrue
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    104. Observation.performer
                                                                                                                    Definition

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

                                                                                                                    ShortWho is responsible for the observation
                                                                                                                    Control0..*
                                                                                                                    TypeReference(Practitioner, PractitionerRole, Organization, CareTeam, Patient, RelatedPerson)
                                                                                                                    Is Modifierfalse
                                                                                                                    Summarytrue
                                                                                                                    Requirements

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

                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    106. Observation.value[x]
                                                                                                                    Definition

                                                                                                                    Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.

                                                                                                                    ShortVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
                                                                                                                    Comments

                                                                                                                    An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.

                                                                                                                    Control0..1
                                                                                                                    This element is affected by the following invariants: obs-7, vs-2
                                                                                                                    TypeQuantity
                                                                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                    Is Modifierfalse
                                                                                                                    Must Supporttrue
                                                                                                                    Summarytrue
                                                                                                                    Requirements
                                                                                                                    1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                    SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                                    • type @ $this
                                                                                                                    • 108. Observation.value[x]:valueQuantity
                                                                                                                      Slice NamevalueQuantity
                                                                                                                      Definition

                                                                                                                      Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.

                                                                                                                      ShortRespiration rate
                                                                                                                      Comments

                                                                                                                      An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the Notes section below.

                                                                                                                      Control0..1
                                                                                                                      This element is affected by the following invariants: obs-7, vs-2, au-core-obs-02
                                                                                                                      TypeQuantity
                                                                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                      Is Modifierfalse
                                                                                                                      Must Supporttrue
                                                                                                                      Obligations
                                                                                                                        ObligationsActor
                                                                                                                        SHALL:populate-if-knownAU Core Responder
                                                                                                                        SHALL:no-errorAU Core Requester
                                                                                                                        Summarytrue
                                                                                                                        Requirements
                                                                                                                        1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        110. Observation.value[x]:valueQuantity.id
                                                                                                                        Definition

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

                                                                                                                        ShortUnique id for inter-element referencing
                                                                                                                        Control0..1
                                                                                                                        Typestring
                                                                                                                        Is Modifierfalse
                                                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                        Summaryfalse
                                                                                                                        112. Observation.value[x]:valueQuantity.extension
                                                                                                                        Definition

                                                                                                                        May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                                        Is Modifierfalse
                                                                                                                        Summaryfalse
                                                                                                                        Alternate Namesextensions, user content
                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                        SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                                        • value @ url
                                                                                                                        • 114. Observation.value[x]:valueQuantity.value
                                                                                                                          Definition

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

                                                                                                                          ShortNumerical value (with implicit precision)
                                                                                                                          Comments

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

                                                                                                                          Control1..1
                                                                                                                          Typedecimal
                                                                                                                          Is Modifierfalse
                                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                          Must Supporttrue
                                                                                                                          Obligations
                                                                                                                            ObligationsActor
                                                                                                                            SHALL:populate-if-knownAU Core Responder
                                                                                                                            SHALL:no-errorAU Core Requester
                                                                                                                            Summarytrue
                                                                                                                            Requirements

                                                                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            116. Observation.value[x]:valueQuantity.comparator
                                                                                                                            Definition

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

                                                                                                                            Short< | <= | >= | > - how to understand the value
                                                                                                                            Control0..1
                                                                                                                            BindingThe codes SHALL be taken from QuantityComparator
                                                                                                                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                                            How the Quantity should be understood and represented.

                                                                                                                            Typecode
                                                                                                                            Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Summarytrue
                                                                                                                            Requirements

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

                                                                                                                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                            118. Observation.value[x]:valueQuantity.unit
                                                                                                                            Definition

                                                                                                                            A human-readable form of the unit.

                                                                                                                            ShortUnit representation
                                                                                                                            Control1..1
                                                                                                                            Typestring
                                                                                                                            Is Modifierfalse
                                                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                            Must Supporttrue
                                                                                                                            Obligations
                                                                                                                              ObligationsActor
                                                                                                                              SHALL:populate-if-knownAU Core Responder
                                                                                                                              SHALL:no-errorAU Core Requester
                                                                                                                              Summarytrue
                                                                                                                              Requirements

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

                                                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                              120. Observation.value[x]:valueQuantity.system
                                                                                                                              Definition

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

                                                                                                                              ShortSystem that defines coded unit form
                                                                                                                              Control1..1
                                                                                                                              This element is affected by the following invariants: qty-3
                                                                                                                              Typeuri
                                                                                                                              Is Modifierfalse
                                                                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                              Must Supporttrue
                                                                                                                              Obligations
                                                                                                                                ObligationsActor
                                                                                                                                SHALL:populate-if-knownAU Core Responder
                                                                                                                                SHALL:no-errorAU Core Requester
                                                                                                                                Summarytrue
                                                                                                                                Requirements

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

                                                                                                                                Fixed Valuehttp://unitsofmeasure.org
                                                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                122. Observation.value[x]:valueQuantity.code
                                                                                                                                Definition

                                                                                                                                Coded responses from the common UCUM units for vital signs value set.

                                                                                                                                ShortCoded responses from the common UCUM units for vital signs value set.
                                                                                                                                Comments

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

                                                                                                                                Control1..1
                                                                                                                                Typecode
                                                                                                                                Is Modifierfalse
                                                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                Must Supporttrue
                                                                                                                                Obligations
                                                                                                                                  ObligationsActor
                                                                                                                                  SHALL:populate-if-knownAU Core Responder
                                                                                                                                  SHALL:no-errorAU Core Requester
                                                                                                                                  Summarytrue
                                                                                                                                  Requirements

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

                                                                                                                                  Fixed Value/min
                                                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                  124. 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, vs-2, au-core-obs-02
                                                                                                                                  BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                                                  (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

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

                                                                                                                                  TypeCodeableConcept
                                                                                                                                  Is Modifierfalse
                                                                                                                                  Must Supporttrue
                                                                                                                                  Obligations
                                                                                                                                    ObligationsActor
                                                                                                                                    SHALL:populate-if-knownAU Core Responder
                                                                                                                                    SHALL:no-errorAU Core Requester
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

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

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    126. Observation.interpretation
                                                                                                                                    Definition

                                                                                                                                    A categorical assessment of an observation value. For example, high, low, normal.

                                                                                                                                    ShortHigh, low, normal, etc.
                                                                                                                                    Comments

                                                                                                                                    Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

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

                                                                                                                                    Codes identifying interpretations of observations.

                                                                                                                                    TypeCodeableConcept
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

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

                                                                                                                                    Alternate NamesAbnormal Flag
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    128. Observation.note
                                                                                                                                    Definition

                                                                                                                                    Comments about the observation or the results.

                                                                                                                                    ShortComments about the observation
                                                                                                                                    Comments

                                                                                                                                    May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                                                                                                                                    Control0..*
                                                                                                                                    TypeAnnotation
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

                                                                                                                                    Need to be able to provide free text additional information.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    130. Observation.bodySite
                                                                                                                                    Definition

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

                                                                                                                                    ShortObserved body part
                                                                                                                                    Comments

                                                                                                                                    Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                                                                                                    If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                                                                                                                                    Control0..1
                                                                                                                                    This element is affected by the following invariants: au-core-obs-04
                                                                                                                                    BindingThe codes SHOULD be taken from Body Site .
                                                                                                                                    (preferred to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                                                                                                                                    TypeCodeableConcept
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
                                                                                                                                    132. 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 ObservationMethods
                                                                                                                                    (example to http://hl7.org/fhir/ValueSet/observation-methods)

                                                                                                                                    Methods for simple observations.

                                                                                                                                    TypeCodeableConcept
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

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

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    134. 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)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    136. Observation.device
                                                                                                                                    Definition

                                                                                                                                    The device used to generate the observation data.

                                                                                                                                    Short(Measurement) Device
                                                                                                                                    Comments

                                                                                                                                    Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                                                                                                                                    Control0..1
                                                                                                                                    TypeReference(Device, DeviceMetric)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    138. Observation.referenceRange
                                                                                                                                    Definition

                                                                                                                                    Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

                                                                                                                                    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 might 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
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    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() or (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())
                                                                                                                                    140. 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.

                                                                                                                                    ShortUnique id for inter-element referencing
                                                                                                                                    Control0..1
                                                                                                                                    Typestring
                                                                                                                                    Is Modifierfalse
                                                                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                    Summaryfalse
                                                                                                                                    142. Observation.referenceRange.extension
                                                                                                                                    Definition

                                                                                                                                    May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Alternate Namesextensions, user content
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                    144. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.

                                                                                                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                                                                                                    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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                                                    Summarytrue
                                                                                                                                    Requirements

                                                                                                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                                                    Alternate Namesextensions, user content, modifiers
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                    146. 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)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    148. 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)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    150. 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
                                                                                                                                    BindingThe codes SHOULD be taken from ObservationReferenceRangeMeaningCodes
                                                                                                                                    (preferred to http://hl7.org/fhir/ValueSet/referencerange-meaning)

                                                                                                                                    Code for the meaning of a reference range.

                                                                                                                                    TypeCodeableConcept
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

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

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    152. 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. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

                                                                                                                                    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 ObservationReferenceRangeAppliesToCodes
                                                                                                                                    (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto)

                                                                                                                                    Codes identifying the population the reference range applies to.

                                                                                                                                    TypeCodeableConcept
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

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

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    154. 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
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summaryfalse
                                                                                                                                    Requirements

                                                                                                                                    Some analytes vary greatly over age.

                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    156. 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
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                    Summaryfalse
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    158. Observation.hasMember
                                                                                                                                    Definition

                                                                                                                                    Used when reporting vital signs panel components.

                                                                                                                                    ShortUsed when reporting vital signs panel components
                                                                                                                                    Comments

                                                                                                                                    When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

                                                                                                                                    Control0..*
                                                                                                                                    TypeReference(QuestionnaireResponse, MolecularSequence, Vital Signs Profile)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summarytrue
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    160. Observation.derivedFrom
                                                                                                                                    Definition

                                                                                                                                    The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.

                                                                                                                                    ShortRelated measurements the observation is made from
                                                                                                                                    Comments

                                                                                                                                    All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

                                                                                                                                    Control0..*
                                                                                                                                    TypeReference(DocumentReference, ImagingStudy, Media, QuestionnaireResponse, MolecularSequence, Vital Signs Profile)
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Summarytrue
                                                                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                    162. Observation.component
                                                                                                                                    Definition

                                                                                                                                    Used when reporting systolic and diastolic blood pressure.

                                                                                                                                    ShortUsed when reporting systolic and diastolic blood pressure.
                                                                                                                                    Comments

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

                                                                                                                                    Control0..*
                                                                                                                                    TypeBackboneElement
                                                                                                                                    Is Modifierfalse
                                                                                                                                    Must Supporttrue
                                                                                                                                    Obligations
                                                                                                                                      ObligationsActor
                                                                                                                                      SHALL:populate-if-knownAU Core Responder
                                                                                                                                      SHALL:no-errorAU Core Requester
                                                                                                                                      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() or (children().count() > id.count()))
                                                                                                                                      vs-3: If there is no a value a data absent reason must be present (value.exists() or dataAbsentReason.exists())
                                                                                                                                      164. 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.

                                                                                                                                      ShortUnique id for inter-element referencing
                                                                                                                                      Control0..1
                                                                                                                                      Typestring
                                                                                                                                      Is Modifierfalse
                                                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                                                      Summaryfalse
                                                                                                                                      166. Observation.component.extension
                                                                                                                                      Definition

                                                                                                                                      May be used to represent additional information that is not part of the basic definition of the element. 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 can 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
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Summaryfalse
                                                                                                                                      Alternate Namesextensions, user content
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                      168. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.

                                                                                                                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                                                                                      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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                                                      Summarytrue
                                                                                                                                      Requirements

                                                                                                                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                                                                      Alternate Namesextensions, user content, modifiers
                                                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                                                      170. Observation.component.code
                                                                                                                                      Definition

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

                                                                                                                                      ShortType of component observation (code / type)
                                                                                                                                      Comments

                                                                                                                                      All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                                                                      Control1..1
                                                                                                                                      BindingUnless not suitable, these codes SHALL be taken from VitalSigns
                                                                                                                                      (extensible to http://hl7.org/fhir/ValueSet/observation-vitalsignresult)

                                                                                                                                      This identifies the vital sign result type.

                                                                                                                                      TypeCodeableConcept
                                                                                                                                      Is Modifierfalse
                                                                                                                                      Must Supporttrue
                                                                                                                                      Obligations
                                                                                                                                        ObligationsActor
                                                                                                                                        SHALL:populate-if-knownAU Core Responder
                                                                                                                                        SHALL:no-errorAU Core Requester
                                                                                                                                        Summarytrue
                                                                                                                                        Requirements

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

                                                                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                        172. Observation.component.value[x]
                                                                                                                                        Definition

                                                                                                                                        Vital Sign Value recorded with UCUM.

                                                                                                                                        ShortVital Sign Value recorded with UCUM
                                                                                                                                        Comments

                                                                                                                                        Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was 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 additional guidance, see the Notes section below.

                                                                                                                                        Control0..1
                                                                                                                                        This element is affected by the following invariants: vs-3
                                                                                                                                        BindingUnless not suitable, these codes SHALL be taken from VitalSignsUnits
                                                                                                                                        (extensible to http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1)

                                                                                                                                        Common UCUM units for recording Vital Signs.

                                                                                                                                        TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                                                                                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                                                                        Is Modifierfalse
                                                                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                                                        Must Supporttrue
                                                                                                                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                                                                        Obligations
                                                                                                                                          ObligationsActor
                                                                                                                                          SHALL:populate-if-knownAU Core Responder
                                                                                                                                          SHALL:no-errorAU Core Requester
                                                                                                                                          Summarytrue
                                                                                                                                          Requirements
                                                                                                                                          1. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
                                                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                          174. Observation.component.dataAbsentReason
                                                                                                                                          Definition

                                                                                                                                          Provides a reason why the expected value in the element Observation.component.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, vs-3
                                                                                                                                          BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                                                                          (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

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

                                                                                                                                          TypeCodeableConcept
                                                                                                                                          Is Modifierfalse
                                                                                                                                          Must Supporttrue
                                                                                                                                          Obligations
                                                                                                                                            ObligationsActor
                                                                                                                                            SHALL:populate-if-knownAU Core Responder
                                                                                                                                            SHALL:no-errorAU Core Requester
                                                                                                                                            Summaryfalse
                                                                                                                                            Requirements

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

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

                                                                                                                                            A categorical assessment of an observation value. For example, high, low, normal.

                                                                                                                                            ShortHigh, low, normal, etc.
                                                                                                                                            Comments

                                                                                                                                            Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

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

                                                                                                                                            Codes identifying interpretations of observations.

                                                                                                                                            TypeCodeableConcept
                                                                                                                                            Is Modifierfalse
                                                                                                                                            Summaryfalse
                                                                                                                                            Requirements

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

                                                                                                                                            Alternate NamesAbnormal Flag
                                                                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                                                            178. 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 might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                                                                            Control0..*
                                                                                                                                            TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                                                                            Is Modifierfalse
                                                                                                                                            Summaryfalse
                                                                                                                                            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() or (children().count() > id.count()))