CH LAB-Report (R4)
1.0.0-ballot - ballot Switzerland flag

This page is part of the CH LAB-Report (R4) (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: ChLabObservation_eGFR_CKD_EPI_male - Detailed Descriptions

Active as of 2024-05-17

Definitions for the ch-lab-observation-egfr-ckd-epi-male resource profile.

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

0. Observation
Impose ProfileThis profile also requires that the instance also conform this additional profile:
2. Observation.code
Definition

GFR estimating equations developed by the Modification of Diet in Renal Disease (MDRD) Study Group and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)....

ShorteGFR_CKD_EPI
Must Supporttrue
Pattern Value{
  "coding" : [{
    "system" : "http://loinc.org",
    "code" : "50044-7",
    "display" : "Glomerular filtration rate/1.73 sq M.predicted among females [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD)"
  }]
}
4. Observation.referenceRange
Control1..3
SlicingThis element introduces a set of slices on Observation.referenceRange. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ age.low.value
  • 6. Observation.referenceRange:child
    Slice Namechild
    Control0..1
    Must Supporttrue
    8. Observation.referenceRange:child.low
    10. Observation.referenceRange:child.low.value
    Pattern Value90
    12. Observation.referenceRange:child.low.unit
    Pattern ValuemL/min
    14. Observation.referenceRange:child.age
    16. Observation.referenceRange:child.age.low
    18. Observation.referenceRange:child.age.low.value
    Control1..?
    Pattern Value0
    20. Observation.referenceRange:child.age.low.unit
    Pattern Valuea
    22. Observation.referenceRange:child.age.high
    24. Observation.referenceRange:child.age.high.value
    Pattern Value30
    26. Observation.referenceRange:child.age.high.unit
    Pattern Valuea
    28. Observation.referenceRange:child.text
    Pattern ValueDie Formel ist nur ab 18 Jahre validiert.
    30. Observation.referenceRange:youth
    Slice Nameyouth
    Control0..1
    Must Supporttrue
    32. Observation.referenceRange:youth.low
    34. Observation.referenceRange:youth.low.value
    Pattern Value90
    36. Observation.referenceRange:youth.low.unit
    Pattern ValuemL/min
    38. Observation.referenceRange:youth.age
    40. Observation.referenceRange:youth.age.low
    42. Observation.referenceRange:youth.age.low.value
    Control1..?
    Pattern Value18
    44. Observation.referenceRange:youth.age.low.unit
    Pattern Valuea
    46. Observation.referenceRange:youth.age.high
    48. Observation.referenceRange:youth.age.high.value
    Pattern Value30
    50. Observation.referenceRange:youth.age.high.unit
    Pattern Valuea
    52. Observation.referenceRange:youth.text
    Pattern ValueDie Formel ist ab 18 bis 93 Jahre validiert.
    54. Observation.referenceRange:adult
    Slice Nameadult
    Control0..1
    Must Supporttrue
    56. Observation.referenceRange:adult.low
    58. Observation.referenceRange:adult.low.value
    Pattern Value60
    60. Observation.referenceRange:adult.low.unit
    Pattern ValuemL/min
    62. Observation.referenceRange:adult.age
    64. Observation.referenceRange:adult.age.low
    66. Observation.referenceRange:adult.age.low.value
    Control1..?
    Pattern Value31
    68. Observation.referenceRange:adult.age.low.unit
    Pattern Valuea
    70. Observation.referenceRange:adult.age.high
    72. Observation.referenceRange:adult.age.high.value
    Pattern Value100
    74. Observation.referenceRange:adult.age.high.unit
    Pattern Valuea
    76. Observation.referenceRange:adult.text
    Pattern ValueDie Formel ist nur bis 93 Jahre validiert.
    78. Observation.component
    Control2..2
    Must Supporttrue
    SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • value @ code
    • 80. Observation.component:blacks
      Slice Nameblacks
      ShorteGFR_CKD_EPI among blacks
      Control1..1
      Must Supporttrue
      82. Observation.component:blacks.extension:value-r5
      Slice Namevalue-r5
      84. Observation.component:blacks.code
      ShorteGFR_CKD_EPI among blacks code
      Pattern Value{
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "88293-6",
          "display" : "Glomerular filtration rate/1.73 sq M.predicted among blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
        }]
      }
      86. Observation.component:blacks.value[x]:valueQuantity
      Slice NamevalueQuantity
      ShortLab Result Component Value
      TypeQuantity(Quantity (Eu Lab))
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Must Supporttrue
      88. Observation.component:blacks.value[x]:valueQuantity.value
      Control1..?
      Must Supporttrue
      90. Observation.component:blacks.value[x]:valueQuantity.unit
      Control1..?
      Must Supporttrue
      92. Observation.component:blacks.value[x]:valueQuantity.code
      Fixed ValuemL/min
      94. Observation.component:non-blacks
      Slice Namenon-blacks
      ShorteGFR_CKD_EPI among non-blacks
      Control1..1
      Must Supporttrue
      96. Observation.component:non-blacks.extension:value-r5
      Slice Namevalue-r5
      98. Observation.component:non-blacks.code
      ShorteGFR_CKD_EPI among non-blacks code
      Pattern Value{
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "88294-4",
          "display" : "Glomerular filtration rate/1.73 sq M.predicted among non-blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
        }]
      }
      100. Observation.component:non-blacks.value[x]:valueQuantity
      Slice NamevalueQuantity
      ShortLab Result Component Value
      TypeQuantity(Quantity (Eu Lab))
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Must Supporttrue
      102. Observation.component:non-blacks.value[x]:valueQuantity.value
      Control1..?
      Must Supporttrue
      104. Observation.component:non-blacks.value[x]:valueQuantity.unit
      Control1..?
      Must Supporttrue
      106. Observation.component:non-blacks.value[x]:valueQuantity.code
      Fixed ValuemL/min

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

      0. Observation
      Definition

      This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as "has-member" child observations


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

      ShortLaboratory result for a simple test or for a panel/studyMeasurements and simple assertions
      Comments

      Represents either a lab simple observation or the group of observations produced by a laboratory study.


      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
      Impose ProfileThis profile also requires that the instance also conform this additional profile:
      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())
      eu-lab-1: If observation status is other then "registered" or "cancelled", at least one of these Observation elements shall be provided: "value", "dataAbsentReason", "hasMember" or "component" ((status in ('registered'|'cancelled')) or value.exists() or hasMember.exists() or component.exists() or dataAbsentReason.exists())
      eu-lab-2: If observation has components and observation status is other then "registered" or "cancelled", at least one of these Observation.component elements shall be provided: "value" or "dataAbsentReason" (component.exists() implies (status in ('registered'|'cancelled')) or component.value.exists() or component.dataAbsentReason.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.extension:supportingInfo
      Slice NamesupportingInfo
      Definition

      Other resources from the patient record that may be relevant to the event. The information from these resources was either used to create the instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available. For example, use Observation.hasMember instead of supportingInformation for representing the members of an Observation panel.

      ShortOther information that may be relevant to this event.
      Control0..*
      TypeExtension(Supporting info) (Extension Type: Reference(Resource))
      Is Modifierfalse
      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())
      ele-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.extension:triggeredBy-r5
      Slice NametriggeredBy-r5
      Definition

      Optional Extension Element - found in all resources.

      ShortOptional Extensions Element
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension Definition for Observation.triggeredBy for Version 5.0) (Complex Extension)
      Is Modifierfalse
      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())
      8. Observation.extension:triggeredBy-r5.extension:observation
      Slice Nameobservation
      Definition

      An Extension

      ShortTriggering observation.Additional content defined by implementations
      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      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())
      10. Observation.extension:triggeredBy-r5.extension:observation.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional content defined by implementations
      Comments

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

      Control0..0*
      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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 12. Observation.extension:triggeredBy-r5.extension:observation.url
        Definition

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

        Shortidentifies the meaning of the extension
        Comments

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

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valueobservation
        14. Observation.extension:triggeredBy-r5.extension:observation.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        TypeReference(Observation), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Observation.extension:triggeredBy-r5.extension:type
        Slice Nametype
        Definition

        An Extension

        ShortThe type of triggerAdditional content defined by implementations
        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        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.extension:triggeredBy-r5.extension:type.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional content defined by implementations
        Comments

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

        Control0..0*
        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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 20. Observation.extension:triggeredBy-r5.extension:type.url
          Definition

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuetype
          22. Observation.extension:triggeredBy-r5.extension:type.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          Typecode, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          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()))
          24. Observation.extension:triggeredBy-r5.extension:reason
          Slice Namereason
          Definition

          An Extension

          ShortExtensionAdditional content defined by implementations
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          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())
          26. Observation.extension:triggeredBy-r5.extension:reason.extension
          Definition

          An Extension


          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.

          ShortExtensionAdditional content defined by implementations
          Comments

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

          Control0..0*
          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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 28. Observation.extension:triggeredBy-r5.extension:reason.url
            Definition

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

            Shortidentifies the meaning of the extension
            Comments

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

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuereason
            30. Observation.extension:triggeredBy-r5.extension:reason.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control10..1
            Typestring, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            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()))
            32. Observation.extension:triggeredBy-r5.url
            Definition

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

            Shortidentifies the meaning of the extension
            Comments

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

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy
            34. Observation.extension:triggeredBy-r5.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control0..01
            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
            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()))
            36. Observation.extension:certifiedRefMaterialCodeable
            Slice NamecertifiedRefMaterialCodeable
            Definition

            This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using a CodeableConcept. This extension should be used when the unit is UCUM [IU].

            ShortCertified Reference Material: CodeableConcept
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Certified Reference Material: CodeableConcept) (Extension Type: CodeableConcept)
            Is Modifierfalse
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            38. Observation.extension:certifiedRefMaterialIdentifer
            Slice NamecertifiedRefMaterialIdentifer
            Definition

            This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using an Identifier. This extension should be used when the unit is UCUM [IU].

            ShortCertified Reference Material: Identifier
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Certified Reference Material: Identifier) (Extension Type: Identifier)
            Is Modifierfalse
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            40. Observation.extension:labTestKit
            Slice NamelabTestKit
            Definition

            This extension links this observation with the laboratory test kit used for this test. Usually only one laboratory test kit is referred

            ShortDevice Laboratory Test Kit
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Device Laboratory Test Kit) (Extension Type: Reference(Device))
            Is Modifierfalse
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            42. Observation.extension:value-r5
            Slice Namevalue-r5
            Definition

            Optional Extension Element - found in all resources.

            Shortonly for result of type Attachment
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
            Is Modifierfalse
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            44. Observation.extension:value-r5.extension
            Definition

            An Extension


            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.

            ShortExtensionAdditional content defined by implementations
            Comments

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

            Control0..0*
            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.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 46. Observation.extension:value-r5.url
              Definition

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

              Shortidentifies the meaning of the extension
              Comments

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

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
              48. Observation.extension:value-r5.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control10..1
              TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. 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())
              52. Observation.status
              Definition

              The status of the result value.

              ShortStatus of this observation (e.g. preliminary, final,...)registered | 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)

              Codes providing the status of an observation.

              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
              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()))
              54. Observation.category
              Definition

              A code that classifies the general type of observation being made. In this profile, fixed to "laboratory".


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

              ShortClassification of type of observation
              Comments

              "laboratory" includes laboratory medicine and pathology


              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
              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:
              • pattern @ $this
              • 56. Observation.category:laboratory
                Slice Namelaboratory
                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
                Summaryfalse
                Requirements

                Used for filtering what observations are retrieved and displayed.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                    "code" : "laboratory"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. Observation.category:studyType
                Slice NamestudyType
                Definition

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

                ShortThe way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)Classification of type of observation
                Comments

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

                Control0..*
                BindingThe codes SHALL be taken from The codes SHOULD be taken from Laboratory Study Typeshttp://hl7.org/fhir/ValueSet/observation-category
                (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab)
                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Used for filtering what observations are retrieved and displayed.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://loinc.org",
                    "code" : "18719-5",
                    "display" : "Chemistry studies (set)"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. Observation.category:specialty
                Slice Namespecialty
                Definition

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

                ShortThe clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)Classification of type of observation
                Comments

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

                Control0..*
                BindingThe codes SHALL be taken from The codes SHOULD be taken from Laboratory Specialtyhttp://hl7.org/fhir/ValueSet/observation-category
                (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab)
                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Used for filtering what observations are retrieved and displayed.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://snomed.info/sct",
                    "code" : "394596001",
                    "display" : "Chemical pathology"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                62. Observation.code
                Definition

                GFR estimating equations developed by the Modification of Diet in Renal Disease (MDRD) Study Group and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)....


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

                ShorteGFR_CKD_EPIType of observation (code / type)
                Comments

                In the context of this Observation-laboratory-uv-ips profile, when the observation plays the role of a grouper of member sub-observations, the code represent the group (for instance a panel code). In case no code is available, at least a text shall be provided.


                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
                BindingThe codes SHOULD be taken from For example codes, see Laboratory Codehttp://hl7.org/fhir/ValueSet/observation-codes
                (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-obsCode-eu-lab)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

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

                Alternate NamesName
                Pattern Value{
                  "coding" : [{
                    "system" : "http://loinc.org",
                    "code" : "50044-7",
                    "display" : "Glomerular filtration rate/1.73 sq M.predicted among females [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD)"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. 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(Patient: Animal, Patient: Person, Group, Device, Location, Patient)
                Is Modifierfalse
                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()))
                66. Observation.subject.reference
                Definition

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

                ShortLiteral reference, Relative, internal or absolute URL
                Comments

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

                Control10..1
                This element is affected by the following invariants: ref-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()))
                68. Observation.effective[x]
                Definition

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

                ShortClinically relevant time/time-period for observation
                Comments

                At least a date should be present unless this observation is a historical report. 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
                TypeChoice of: dateTime, Period, Timing, instant
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

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

                Alternate NamesOccurrence
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. Observation.effective[x].extension:data-absent-reason
                Slice Namedata-absent-reason
                Definition

                Provides a reason why the effectiveTime is missing.

                Shorteffective[x] absence reason
                Control0..1
                TypeExtension(Data Absent Reason) (Extension Type: code)
                Is Modifierfalse
                Summaryfalse
                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())
                72. Observation.performer
                Definition

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

                ShortWho is responsible for the observation
                Control10..*
                TypeReference(CH LAB PractitionerRole, CH LAB Practitioner, CH Core Organization, CareTeam, CH LAB Patient, RelatedPerson, Practitioner, PractitionerRole, Organization, Patient)
                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()))
                74. Observation.performer.extension:performerFunction
                Slice NameperformerFunction
                Definition

                Distinguishes the type of involvement of the performer in the event. For example, 'author', 'verifier' or 'responsible party'.

                ShortType of performance
                Control0..*
                TypeExtension(Performer function) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Summaryfalse
                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())
                76. Observation.value[x]
                Definition

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

                ShortActual result
                Comments

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

                An observation exists to have a value, though it 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 Open, and can be differentiated using the following discriminators:
                • type @ $this
                • 78. Observation.value[x]:valueString
                  Slice NamevalueString
                  Definition

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

                  ShortActual 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.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  Typestring, dateTime, boolean, SampledData, Quantity, Period, Ratio, integer, time, Range, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it 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()))
                  80. Observation.value[x]:valueRange
                  Slice NamevalueRange
                  Definition

                  A set of ordered Quantities defined by a low and high limit.


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

                  ShortSet of values bounded by low and highActual result
                  Comments

                  The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.


                  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: ele-1, obs-7
                  TypeRange(Range (IPS)), dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Requirements

                  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()))
                  rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                  82. Observation.value[x]:valueRatio
                  Slice NamevalueRatio
                  Definition

                  A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.


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

                  ShortA measured ratio using UCUMActual result
                  Comments

                  The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.


                  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: ele-1, obs-7
                  TypeRatio(Ratio (Eu Lab)), dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Requirements

                  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()))
                  rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                  84. Observation.value[x]:valueTime
                  Slice NamevalueTime
                  Definition

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

                  ShortActual 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.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  Typetime, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, Range, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it 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()))
                  86. Observation.value[x]:valueDateTime
                  Slice NamevalueDateTime
                  Definition

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

                  ShortActual 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.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  TypedateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it 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()))
                  88. Observation.value[x]:valuePeriod
                  Slice NamevaluePeriod
                  Definition

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

                  ShortActual 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.

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

                  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()))
                  90. Observation.value[x]:valueQuantity
                  Slice NamevalueQuantity
                  Definition

                  A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.


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

                  ShortA measured amount using UCUMActual result
                  Comments

                  The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.


                  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: ele-1, obs-7
                  TypeQuantity(Quantity (Eu Lab)), dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                  Is Modifierfalse
                  Requirements

                  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()))
                  qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                  92. Observation.value[x]:valueCodeableConcept
                  Slice NamevalueCodeableConcept
                  Definition

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

                  ShortActual 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.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  BindingThe codes SHOULD be taken from For codes, see Results Coded Values Laboratory - IPS
                  (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                  Additional BindingsPurposeDocumentation
                  Results Blood Group - SNOMED CT IPS Free Setcandidate

                  Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                  Results Presence Absence - SNOMED CT IPS Free Setcandidate

                  Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                  Results Microorganism - SNOMED CT IPS Free Setcandidate

                  Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                  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()))
                  94. 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.

                  Control10..3*
                  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())
                  obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                  SlicingThis element introduces a set of slices on Observation.referenceRange. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ age.low.value
                  • 96. 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())
                    98. Observation.referenceRange:child
                    Slice Namechild
                    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..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    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())
                    obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                    100. Observation.referenceRange:child.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())
                    102. Observation.referenceRange:child.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
                    Pattern ValueDie Formel ist nur ab 18 Jahre validiert.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. Observation.referenceRange:youth
                    Slice Nameyouth
                    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..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    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())
                    obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                    106. Observation.referenceRange:youth.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())
                    108. Observation.referenceRange:youth.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
                    Pattern ValueDie Formel ist ab 18 bis 93 Jahre validiert.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    110. Observation.referenceRange:adult
                    Slice Nameadult
                    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..1*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    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())
                    obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                    112. Observation.referenceRange:adult.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())
                    114. Observation.referenceRange:adult.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
                    Pattern ValueDie Formel ist nur bis 93 Jahre validiert.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    116. Observation.hasMember
                    Definition

                    A reference to another Observation profiled by ch-lab-observation-results-laboratory. The target observation (for instance an individual test member of a panel) is considered as a sub-observation of the current one, which plays the role of a grouper.


                    This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

                    ShortRelated resource that belongs to the Observation group
                    Comments

                    This element is used in the context of international patient summary when there is a need to group a collection of observations, because they belong to the same panel, or because they share a common interpretation comment, or a common media attachment (illustrative image or graph). In these cases, the current observation is the grouper, and its set of sub-observations are related observations using the type "has-member". For a discussion on the ways Observations can be assembled in groups together see Observation Grouping.


                    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..0*
                    TypeReference(CH LAB Observation Results: Laboratory Report, Observation, QuestionnaireResponse, MolecularSequence)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    118. Observation.component
                    Definition

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

                    ShortLaboratory resultComponent results
                    Comments

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

                    Control20..2*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    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()))
                    SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • value @ code
                    • 120. Observation.component.extension:value-r5
                      Slice Namevalue-r5
                      Definition

                      Optional Extension Element - found in all resources.

                      Shortonly for result of type Attachment
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                      Is Modifierfalse
                      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())
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      122. Observation.component.extension:value-r5.extension
                      Definition

                      An Extension


                      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.

                      ShortExtensionAdditional content defined by implementations
                      Comments

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

                      Control0..0*
                      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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 124. Observation.component.extension:value-r5.url
                        Definition

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

                        Shortidentifies the meaning of the extension
                        Comments

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

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                        126. Observation.component.extension:value-r5.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control10..1
                        TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        128. 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())
                        130. 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
                        BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes
                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Is Modifierfalse
                        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()))
                        132. Observation.component.value[x]
                        Definition

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

                        ShortActual component result
                        Comments

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

                        An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 134. Observation.component.value[x]:valueString
                          Slice NamevalueString
                          Definition

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

                          ShortActual 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.

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

                          An observation exists to have a value, though it 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()))
                          136. Observation.component.value[x]:valueRange
                          Slice NamevalueRange
                          Definition

                          A set of ordered Quantities defined by a low and high limit.


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

                          ShortSet of values bounded by low and highActual component result
                          Comments

                          The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.


                          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: ele-1
                          TypeRange(Range (IPS)), dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Is Modifierfalse
                          Requirements

                          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()))
                          rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                          138. Observation.component.value[x]:valueRatio
                          Slice NamevalueRatio
                          Definition

                          A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.


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

                          ShortA measured ratio using UCUMActual component result
                          Comments

                          The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.


                          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: ele-1
                          TypeRatio(Ratio (Eu Lab)), dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Is Modifierfalse
                          Requirements

                          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()))
                          rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                          140. Observation.component.value[x]:valueTime
                          Slice NamevalueTime
                          Definition

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

                          ShortActual 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.

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

                          An observation exists to have a value, though it 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()))
                          142. Observation.component.value[x]:valueDateTime
                          Slice NamevalueDateTime
                          Definition

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

                          ShortActual 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.

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

                          An observation exists to have a value, though it 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()))
                          144. Observation.component.value[x]:valuePeriod
                          Slice NamevaluePeriod
                          Definition

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

                          ShortActual 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.

                          Control0..1
                          TypePeriod, dateTime, boolean, string, SampledData, Quantity, Ratio, integer, time, Range, CodeableConcept
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          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()))
                          146. Observation.component.value[x]:valueQuantity
                          Slice NamevalueQuantity
                          Definition

                          A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.


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

                          ShortA measured amount using UCUMActual component result
                          Comments

                          The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.


                          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: ele-1
                          TypeQuantity(Quantity (Eu Lab)), dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          Is Modifierfalse
                          Requirements

                          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()))
                          qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                          148. Observation.component.value[x]:valueCodeableConcept
                          Slice NamevalueCodeableConcept
                          Definition

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

                          ShortActual 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.

                          Control0..1
                          BindingThe codes SHOULD be taken from For codes, see Results Coded Values Laboratory - IPS
                          (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                          Additional BindingsPurposeDocumentation
                          Results Blood Group - SNOMED CT IPS Free Setcandidate

                          Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                          Results Presence Absence - SNOMED CT IPS Free Setcandidate

                          Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                          Results Microorganism - SNOMED CT IPS Free Setcandidate

                          Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                          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()))
                          150. Observation.component:blacks
                          Slice Nameblacks
                          Definition

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

                          ShorteGFR_CKD_EPI among blacksComponent results
                          Comments

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

                          Control10..1*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          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()))
                          152. Observation.component:blacks.extension:value-r5
                          Slice Namevalue-r5
                          Definition

                          An Extension

                          ShortExtension
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                          Is Modifierfalse
                          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())
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          154. Observation.component:blacks.extension:value-r5.extension
                          Definition

                          An Extension


                          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.

                          ShortExtensionAdditional content defined by implementations
                          Comments

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

                          Control0..0*
                          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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 156. Observation.component:blacks.extension:value-r5.url
                            Definition

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

                            Shortidentifies the meaning of the extension
                            Comments

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

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                            158. Observation.component:blacks.extension:value-r5.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control10..1
                            TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            160. Observation.component:blacks.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())
                            162. Observation.component:blacks.code
                            Definition

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

                            ShorteGFR_CKD_EPI among blacks codeType 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
                            BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes
                            (example to http://hl7.org/fhir/ValueSet/observation-codes)

                            Codes identifying names of simple observations.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

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

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://loinc.org",
                                "code" : "88293-6",
                                "display" : "Glomerular filtration rate/1.73 sq M.predicted among blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            164. Observation.component:blacks.value[x]
                            Definition

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

                            ShortActual 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.

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

                            An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 166. Observation.component:blacks.value[x]:valueQuantity
                              Slice NamevalueQuantity
                              Definition

                              A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.


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

                              ShortLab Result Component ValueActual component result
                              Comments

                              The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.


                              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: ele-1
                              TypeQuantity(Quantity (Eu Lab)), dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Is Modifierfalse
                              Must Supporttrue
                              Requirements

                              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()))
                              qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                              168. Observation.component:blacks.value[x]:valueQuantity.extension:uncertainty
                              Slice Nameuncertainty
                              Definition

                              The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

                              ShortStandard Deviation (same units as the quantity)
                              Comments

                              standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

                              Control0..1
                              TypeExtension(Uncertainty) (Extension Type: decimal)
                              Is Modifierfalse
                              Summaryfalse
                              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:blacks.value[x]:valueQuantity.extension:uncertaintyType
                              Slice NameuncertaintyType
                              Definition

                              A code specifying the type of probability distribution for the uncertainty.

                              ShortProbability Distribution Type for uncertainty
                              Comments

                              This is only meaningful if there is also an uncertainty extension. If there is an uncertainty extension with no type, this means that the probability distribution type is unknown. In that case, the uncertainty has the meaning of an informal guess.

                              Control0..1
                              TypeExtension(Uncertainty type) (Extension Type: code)
                              Is Modifierfalse
                              Summaryfalse
                              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())
                              172. Observation.component:blacks.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
                              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()))
                              174. Observation.component:blacks.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()))
                              176. Observation.component:blacks.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
                              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()))
                              178. Observation.component:blacks.value[x]:valueQuantity.system
                              Definition

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

                              ShortUCUM system for unitsSystem 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
                              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()))
                              180. Observation.component:blacks.value[x]:valueQuantity.code
                              Definition

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

                              ShortCoded 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
                              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 ValuemL/min
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              182. Observation.component:blacks.value[x]:valueString
                              Slice NamevalueString
                              Definition

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

                              ShortActual 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.

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

                              An observation exists to have a value, though it 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()))
                              184. Observation.component:blacks.value[x]:valueRange
                              Slice NamevalueRange
                              Definition

                              A set of ordered Quantities defined by a low and high limit.


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

                              ShortSet of values bounded by low and highActual component result
                              Comments

                              The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.


                              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: ele-1
                              TypeRange(Range (IPS)), dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Is Modifierfalse
                              Requirements

                              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()))
                              rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                              186. Observation.component:blacks.value[x]:valueRatio
                              Slice NamevalueRatio
                              Definition

                              A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.


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

                              ShortA measured ratio using UCUMActual component result
                              Comments

                              The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.


                              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: ele-1
                              TypeRatio(Ratio (Eu Lab)), dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Is Modifierfalse
                              Requirements

                              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()))
                              rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                              188. Observation.component:blacks.value[x]:valueTime
                              Slice NamevalueTime
                              Definition

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

                              ShortActual 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.

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

                              An observation exists to have a value, though it 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()))
                              190. Observation.component:blacks.value[x]:valueDateTime
                              Slice NamevalueDateTime
                              Definition

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

                              ShortActual 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.

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

                              An observation exists to have a value, though it 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()))
                              192. Observation.component:blacks.value[x]:valuePeriod
                              Slice NamevaluePeriod
                              Definition

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

                              ShortActual 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.

                              Control0..1
                              TypePeriod, dateTime, boolean, string, SampledData, Quantity, Ratio, integer, time, Range, CodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              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()))
                              194. Observation.component:blacks.value[x]:valueCodeableConcept
                              Slice NamevalueCodeableConcept
                              Definition

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

                              ShortActual 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.

                              Control0..1
                              BindingThe codes SHOULD be taken from For codes, see Results Coded Values Laboratory - IPS
                              (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                              Additional BindingsPurposeDocumentation
                              Results Blood Group - SNOMED CT IPS Free Setcandidate

                              Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                              Results Presence Absence - SNOMED CT IPS Free Setcandidate

                              Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                              Results Microorganism - SNOMED CT IPS Free Setcandidate

                              Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                              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()))
                              196. Observation.component:non-blacks
                              Slice Namenon-blacks
                              Definition

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

                              ShorteGFR_CKD_EPI among non-blacksComponent results
                              Comments

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

                              Control10..1*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              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()))
                              198. Observation.component:non-blacks.extension:value-r5
                              Slice Namevalue-r5
                              Definition

                              An Extension

                              ShortExtension
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                              Is Modifierfalse
                              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())
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              200. Observation.component:non-blacks.extension:value-r5.extension
                              Definition

                              An Extension


                              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.

                              ShortExtensionAdditional content defined by implementations
                              Comments

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

                              Control0..0*
                              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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 202. Observation.component:non-blacks.extension:value-r5.url
                                Definition

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

                                Shortidentifies the meaning of the extension
                                Comments

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

                                Control1..1
                                Typeuri
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                                204. Observation.component:non-blacks.extension:value-r5.value[x]
                                Definition

                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                ShortValue of extension
                                Control10..1
                                TypeAttachment, date, Meta, Address, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                206. Observation.component:non-blacks.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())
                                208. Observation.component:non-blacks.code
                                Definition

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

                                ShorteGFR_CKD_EPI among non-blacks codeType 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
                                BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes
                                (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                Codes identifying names of simple observations.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summarytrue
                                Requirements

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

                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://loinc.org",
                                    "code" : "88294-4",
                                    "display" : "Glomerular filtration rate/1.73 sq M.predicted among non-blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
                                  }]
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                210. Observation.component:non-blacks.value[x]
                                Definition

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

                                ShortActual 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.

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

                                An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 212. Observation.component:non-blacks.value[x]:valueQuantity
                                  Slice NamevalueQuantity
                                  Definition

                                  A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.


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

                                  ShortLab Result Component ValueActual component result
                                  Comments

                                  The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.


                                  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: ele-1
                                  TypeQuantity(Quantity (Eu Lab)), dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Requirements

                                  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()))
                                  qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                  214. Observation.component:non-blacks.value[x]:valueQuantity.extension:uncertainty
                                  Slice Nameuncertainty
                                  Definition

                                  The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

                                  ShortStandard Deviation (same units as the quantity)
                                  Comments

                                  standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

                                  Control0..1
                                  TypeExtension(Uncertainty) (Extension Type: decimal)
                                  Is Modifierfalse
                                  Summaryfalse
                                  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())
                                  216. Observation.component:non-blacks.value[x]:valueQuantity.extension:uncertaintyType
                                  Slice NameuncertaintyType
                                  Definition

                                  A code specifying the type of probability distribution for the uncertainty.

                                  ShortProbability Distribution Type for uncertainty
                                  Comments

                                  This is only meaningful if there is also an uncertainty extension. If there is an uncertainty extension with no type, this means that the probability distribution type is unknown. In that case, the uncertainty has the meaning of an informal guess.

                                  Control0..1
                                  TypeExtension(Uncertainty type) (Extension Type: code)
                                  Is Modifierfalse
                                  Summaryfalse
                                  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())
                                  218. Observation.component:non-blacks.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
                                  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()))
                                  220. Observation.component:non-blacks.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()))
                                  222. Observation.component:non-blacks.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
                                  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()))
                                  224. Observation.component:non-blacks.value[x]:valueQuantity.system
                                  Definition

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

                                  ShortUCUM system for unitsSystem 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
                                  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()))
                                  226. Observation.component:non-blacks.value[x]:valueQuantity.code
                                  Definition

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

                                  ShortCoded 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
                                  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 ValuemL/min
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  228. Observation.component:non-blacks.value[x]:valueString
                                  Slice NamevalueString
                                  Definition

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

                                  ShortActual 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.

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

                                  An observation exists to have a value, though it 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()))
                                  230. Observation.component:non-blacks.value[x]:valueRange
                                  Slice NamevalueRange
                                  Definition

                                  A set of ordered Quantities defined by a low and high limit.


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

                                  ShortSet of values bounded by low and highActual component result
                                  Comments

                                  The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.


                                  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: ele-1
                                  TypeRange(Range (IPS)), dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Requirements

                                  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()))
                                  rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                                  232. Observation.component:non-blacks.value[x]:valueRatio
                                  Slice NamevalueRatio
                                  Definition

                                  A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.


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

                                  ShortA measured ratio using UCUMActual component result
                                  Comments

                                  The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.


                                  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: ele-1
                                  TypeRatio(Ratio (Eu Lab)), dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Requirements

                                  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()))
                                  rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                                  234. Observation.component:non-blacks.value[x]:valueTime
                                  Slice NamevalueTime
                                  Definition

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

                                  ShortActual 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.

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

                                  An observation exists to have a value, though it 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()))
                                  236. Observation.component:non-blacks.value[x]:valueDateTime
                                  Slice NamevalueDateTime
                                  Definition

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

                                  ShortActual 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.

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

                                  An observation exists to have a value, though it 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()))
                                  238. Observation.component:non-blacks.value[x]:valuePeriod
                                  Slice NamevaluePeriod
                                  Definition

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

                                  ShortActual 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.

                                  Control0..1
                                  TypePeriod, dateTime, boolean, string, SampledData, Quantity, Ratio, integer, time, Range, CodeableConcept
                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  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()))
                                  240. Observation.component:non-blacks.value[x]:valueCodeableConcept
                                  Slice NamevalueCodeableConcept
                                  Definition

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

                                  ShortActual 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.

                                  Control0..1
                                  BindingThe codes SHOULD be taken from For codes, see Results Coded Values Laboratory - IPS
                                  (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                                  Additional BindingsPurposeDocumentation
                                  Results Blood Group - SNOMED CT IPS Free Setcandidate

                                  Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                  Results Presence Absence - SNOMED CT IPS Free Setcandidate

                                  Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                  Results Microorganism - SNOMED CT IPS Free Setcandidate

                                  Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                                  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()))

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

                                  0. Observation
                                  Definition

                                  This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as "has-member" child observations

                                  ShortLaboratory result for a simple test or for a panel/study
                                  Comments

                                  Represents either a lab simple observation or the group of observations produced by a laboratory study.

                                  Control0..*
                                  Is Modifierfalse
                                  Impose ProfileThis profile also requires that the instance also conform this additional profile:
                                  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())
                                  eu-lab-1: If observation status is other then "registered" or "cancelled", at least one of these Observation elements shall be provided: "value", "dataAbsentReason", "hasMember" or "component" ((status in ('registered'|'cancelled')) or value.exists() or hasMember.exists() or component.exists() or dataAbsentReason.exists())
                                  eu-lab-2: If observation has components and observation status is other then "registered" or "cancelled", at least one of these Observation.component elements shall be provided: "value" or "dataAbsentReason" (component.exists() implies (status in ('registered'|'cancelled')) or component.value.exists() or component.dataAbsentReason.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

                                  The laboratory test kit used for this test.

                                  ShortLaboratory Test Kit
                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 16. Observation.extension:supportingInfo
                                    Slice NamesupportingInfo
                                    Definition

                                    Other resources from the patient record that may be relevant to the event. The information from these resources was either used to create the instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available. For example, use Observation.hasMember instead of supportingInformation for representing the members of an Observation panel.

                                    ShortOther information that may be relevant to this event.
                                    Control0..*
                                    TypeExtension(Supporting info) (Extension Type: Reference(Resource))
                                    Is Modifierfalse
                                    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.extension:triggeredBy-r5
                                    Slice NametriggeredBy-r5
                                    Definition

                                    Optional Extension Element - found in all resources.

                                    ShortOptional Extensions Element
                                    Control0..*
                                    This element is affected by the following invariants: ele-1
                                    TypeExtension(Extension Definition for Observation.triggeredBy for Version 5.0) (Complex Extension)
                                    Is Modifierfalse
                                    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())
                                    20. Observation.extension:triggeredBy-r5.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
                                    22. Observation.extension:triggeredBy-r5.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.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 24. Observation.extension:triggeredBy-r5.extension:observation
                                      Slice Nameobservation
                                      Definition

                                      An Extension

                                      ShortTriggering observation.
                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      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())
                                      26. Observation.extension:triggeredBy-r5.extension:observation.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
                                      28. Observation.extension:triggeredBy-r5.extension:observation.extension
                                      Definition

                                      An Extension

                                      ShortExtension
                                      Control0..0
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 30. Observation.extension:triggeredBy-r5.extension:observation.url
                                        Definition

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

                                        Shortidentifies the meaning of the extension
                                        Comments

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

                                        Control1..1
                                        Typeuri
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        Fixed Valueobservation
                                        32. Observation.extension:triggeredBy-r5.extension:observation.value[x]
                                        Definition

                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                        ShortValue of extension
                                        Control1..1
                                        TypeReference(Observation)
                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        34. Observation.extension:triggeredBy-r5.extension:type
                                        Slice Nametype
                                        Definition

                                        An Extension

                                        ShortThe type of trigger
                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        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())
                                        36. Observation.extension:triggeredBy-r5.extension:type.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.extension:triggeredBy-r5.extension:type.extension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control0..0
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 40. Observation.extension:triggeredBy-r5.extension:type.url
                                          Definition

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

                                          Shortidentifies the meaning of the extension
                                          Comments

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

                                          Control1..1
                                          Typeuri
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          Fixed Valuetype
                                          42. Observation.extension:triggeredBy-r5.extension:type.value[x]
                                          Definition

                                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                          ShortValue of extension
                                          Control1..1
                                          Typecode
                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                          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()))
                                          44. Observation.extension:triggeredBy-r5.extension:reason
                                          Slice Namereason
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          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())
                                          46. Observation.extension:triggeredBy-r5.extension:reason.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
                                          48. Observation.extension:triggeredBy-r5.extension:reason.extension
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..0
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 50. Observation.extension:triggeredBy-r5.extension:reason.url
                                            Definition

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

                                            Shortidentifies the meaning of the extension
                                            Comments

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

                                            Control1..1
                                            Typeuri
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Fixed Valuereason
                                            52. Observation.extension:triggeredBy-r5.extension:reason.value[x]
                                            Definition

                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                            ShortValue of extension
                                            Control1..1
                                            Typestring
                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                            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()))
                                            54. Observation.extension:triggeredBy-r5.url
                                            Definition

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

                                            Shortidentifies the meaning of the extension
                                            Comments

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

                                            Control1..1
                                            Typeuri
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy
                                            56. Observation.extension:triggeredBy-r5.value[x]
                                            Definition

                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                            ShortValue of extension
                                            Control0..0
                                            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                                            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()))
                                            58. Observation.extension:certifiedRefMaterialCodeable
                                            Slice NamecertifiedRefMaterialCodeable
                                            Definition

                                            This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using a CodeableConcept. This extension should be used when the unit is UCUM [IU].

                                            ShortCertified Reference Material: CodeableConcept
                                            Control0..*
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Certified Reference Material: CodeableConcept) (Extension Type: CodeableConcept)
                                            Is Modifierfalse
                                            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.extension:certifiedRefMaterialIdentifer
                                            Slice NamecertifiedRefMaterialIdentifer
                                            Definition

                                            This extension links this observation with the certified reference material used for the calibration. The certified reference material is identified by using an Identifier. This extension should be used when the unit is UCUM [IU].

                                            ShortCertified Reference Material: Identifier
                                            Control0..*
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Certified Reference Material: Identifier) (Extension Type: Identifier)
                                            Is Modifierfalse
                                            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())
                                            62. Observation.extension:labTestKit
                                            Slice NamelabTestKit
                                            Definition

                                            This extension links this observation with the laboratory test kit used for this test. Usually only one laboratory test kit is referred

                                            ShortDevice Laboratory Test Kit
                                            Control0..*
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Device Laboratory Test Kit) (Extension Type: Reference(Device))
                                            Is Modifierfalse
                                            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())
                                            64. Observation.extension:value-r5
                                            Slice Namevalue-r5
                                            Definition

                                            Optional Extension Element - found in all resources.

                                            Shortonly for result of type Attachment
                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                                            Is Modifierfalse
                                            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())
                                            66. Observation.extension:value-r5.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
                                            68. Observation.extension:value-r5.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Control0..0
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            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.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 70. Observation.extension:value-r5.url
                                              Definition

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

                                              Shortidentifies the meaning of the extension
                                              Comments

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

                                              Control1..1
                                              Typeuri
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                                              72. Observation.extension:value-r5.value[x]
                                              Definition

                                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                              ShortValue of extension
                                              Control1..1
                                              TypeAttachment
                                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              74. 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())
                                              76. 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()))
                                              78. 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()))
                                              80. 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()))
                                              82. Observation.status
                                              Definition

                                              The status of the result value.

                                              ShortStatus of this observation (e.g. preliminary, final,...)
                                              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)

                                              Codes providing the status of an observation.

                                              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
                                              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()))
                                              84. Observation.category
                                              Definition

                                              A code that classifies the general type of observation being made. In this profile, fixed to "laboratory".

                                              ShortClassification of type of observation
                                              Comments

                                              "laboratory" includes laboratory medicine and pathology

                                              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
                                              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:
                                              • pattern @ $this
                                              • 86. Observation.category:laboratory
                                                Slice Namelaboratory
                                                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
                                                Summaryfalse
                                                Requirements

                                                Used for filtering what observations are retrieved and displayed.

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                                                    "code" : "laboratory"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                88. Observation.category:studyType
                                                Slice NamestudyType
                                                Definition

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

                                                ShortThe way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
                                                Comments

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

                                                Control0..*
                                                BindingThe codes SHALL be taken from Laboratory Study Types
                                                (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Used for filtering what observations are retrieved and displayed.

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://loinc.org",
                                                    "code" : "18719-5",
                                                    "display" : "Chemistry studies (set)"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                90. Observation.category:specialty
                                                Slice Namespecialty
                                                Definition

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

                                                ShortThe clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
                                                Comments

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

                                                Control0..*
                                                BindingThe codes SHALL be taken from Laboratory Specialty
                                                (required to http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Used for filtering what observations are retrieved and displayed.

                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://snomed.info/sct",
                                                    "code" : "394596001",
                                                    "display" : "Chemical pathology"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                92. Observation.code
                                                Definition

                                                GFR estimating equations developed by the Modification of Diet in Renal Disease (MDRD) Study Group and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)....

                                                ShorteGFR_CKD_EPI
                                                Comments

                                                In the context of this Observation-laboratory-uv-ips profile, when the observation plays the role of a grouper of member sub-observations, the code represent the group (for instance a panel code). In case no code is available, at least a text shall be provided.

                                                Control1..1
                                                BindingThe codes SHOULD be taken from Laboratory Code
                                                (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-obsCode-eu-lab)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

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

                                                Alternate NamesName
                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://loinc.org",
                                                    "code" : "50044-7",
                                                    "display" : "Glomerular filtration rate/1.73 sq M.predicted among females [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD)"
                                                  }]
                                                }
                                                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(Patient: Animal, Patient: Person, Group, Device, Location)
                                                Is Modifierfalse
                                                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.subject.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
                                                98. Observation.subject.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.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 100. Observation.subject.reference
                                                  Definition

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

                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                  Comments

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

                                                  Control1..1
                                                  This element is affected by the following invariants: ref-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()))
                                                  102. Observation.subject.type
                                                  Definition

                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                  ShortType the reference refers to (e.g. "Patient")
                                                  Comments

                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                  Aa resource (or, for logical models, the URI of the logical model).

                                                  Typeuri
                                                  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.subject.identifier
                                                  Definition

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

                                                  ShortLogical reference, when literal reference is not known
                                                  Comments

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

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

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

                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..1
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  106. Observation.subject.display
                                                  Definition

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

                                                  ShortText alternative for the resource
                                                  Comments

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

                                                  Control0..1
                                                  Typestring
                                                  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()))
                                                  108. 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()))
                                                  110. 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()))
                                                  112. Observation.effective[x]
                                                  Definition

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

                                                  ShortClinically relevant time/time-period for observation
                                                  Comments

                                                  At least a date should be present unless this observation is a historical report. 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
                                                  TypeChoice of: dateTime, Period
                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

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

                                                  Alternate NamesOccurrence
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  114. Observation.effective[x].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
                                                  116. Observation.effective[x].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.effective[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 118. Observation.effective[x].extension:data-absent-reason
                                                    Slice Namedata-absent-reason
                                                    Definition

                                                    Provides a reason why the effectiveTime is missing.

                                                    Shorteffective[x] absence reason
                                                    Control0..1
                                                    TypeExtension(Data Absent Reason) (Extension Type: code)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    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())
                                                    120. 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 result 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()))
                                                    122. Observation.performer
                                                    Definition

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

                                                    ShortWho is responsible for the observation
                                                    Control1..*
                                                    TypeReference(CH LAB PractitionerRole, CH LAB Practitioner, CH Core Organization, CareTeam, CH LAB 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()))
                                                    124. Observation.performer.id
                                                    Definition

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

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    126. Observation.performer.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.performer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 128. Observation.performer.extension:performerFunction
                                                      Slice NameperformerFunction
                                                      Definition

                                                      Distinguishes the type of involvement of the performer in the event. For example, 'author', 'verifier' or 'responsible party'.

                                                      ShortType of performance
                                                      Control0..*
                                                      TypeExtension(Performer function) (Extension Type: CodeableConcept)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      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())
                                                      130. Observation.performer.reference
                                                      Definition

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

                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                      Comments

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

                                                      Control0..1
                                                      This element is affected by the following invariants: ref-1
                                                      Typestring
                                                      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()))
                                                      132. Observation.performer.type
                                                      Definition

                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                      ShortType the reference refers to (e.g. "Patient")
                                                      Comments

                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                      Aa resource (or, for logical models, the URI of the logical model).

                                                      Typeuri
                                                      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()))
                                                      134. Observation.performer.identifier
                                                      Definition

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

                                                      ShortLogical reference, when literal reference is not known
                                                      Comments

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

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

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

                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      136. Observation.performer.display
                                                      Definition

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

                                                      ShortText alternative for the resource
                                                      Comments

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

                                                      Control0..1
                                                      Typestring
                                                      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()))
                                                      138. Observation.value[x]
                                                      Definition

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

                                                      ShortActual 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.

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

                                                      An observation exists to have a value, though it 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 Open, and can be differentiated using the following discriminators:
                                                      • type @ $this
                                                      • 140. Observation.value[x]:valueString
                                                        Slice NamevalueString
                                                        Definition

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

                                                        ShortActual 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.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-7
                                                        Typestring
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        An observation exists to have a value, though it 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()))
                                                        142. Observation.value[x]:valueRange
                                                        Slice NamevalueRange
                                                        Definition

                                                        A set of ordered Quantities defined by a low and high limit.

                                                        ShortSet of values bounded by low and high
                                                        Comments

                                                        The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

                                                        Control0..1
                                                        This element is affected by the following invariants: ele-1
                                                        TypeRange(Range (IPS))
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Requirements

                                                        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()))
                                                        rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                                                        144. Observation.value[x]:valueRatio
                                                        Slice NamevalueRatio
                                                        Definition

                                                        A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.

                                                        ShortA measured ratio using UCUM
                                                        Comments

                                                        The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.

                                                        Control0..1
                                                        This element is affected by the following invariants: ele-1
                                                        TypeRatio(Ratio (Eu Lab))
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Requirements

                                                        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()))
                                                        rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                                                        146. Observation.value[x]:valueTime
                                                        Slice NamevalueTime
                                                        Definition

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

                                                        ShortActual 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.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-7
                                                        Typetime
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        An observation exists to have a value, though it 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()))
                                                        148. Observation.value[x]:valueDateTime
                                                        Slice NamevalueDateTime
                                                        Definition

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

                                                        ShortActual 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.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-7
                                                        TypedateTime
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        An observation exists to have a value, though it 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()))
                                                        150. Observation.value[x]:valuePeriod
                                                        Slice NamevaluePeriod
                                                        Definition

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

                                                        ShortActual 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.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-7
                                                        TypePeriod
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

                                                        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()))
                                                        152. Observation.value[x]:valueQuantity
                                                        Slice NamevalueQuantity
                                                        Definition

                                                        A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.

                                                        ShortA measured amount using UCUM
                                                        Comments

                                                        The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

                                                        Control0..1
                                                        This element is affected by the following invariants: ele-1
                                                        TypeQuantity(Quantity (Eu Lab))
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Requirements

                                                        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()))
                                                        qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                                        154. Observation.value[x]:valueCodeableConcept
                                                        Slice NamevalueCodeableConcept
                                                        Definition

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

                                                        ShortActual 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.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-7
                                                        BindingThe codes SHOULD be taken from Results Coded Values Laboratory - IPS
                                                        (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                                                        Additional BindingsPurposeDocumentation
                                                        Results Blood Group - SNOMED CT IPS Free Setcandidate

                                                        Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                        Results Presence Absence - SNOMED CT IPS Free Setcandidate

                                                        Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                        Results Microorganism - SNOMED CT IPS Free Setcandidate

                                                        Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                                                        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()))
                                                        156. Observation.dataAbsentReason
                                                        Definition

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

                                                        ShortProvides a reason why the expected value is missing.
                                                        Comments

                                                        Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                                                        The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                                                        Control0..1
                                                        This element is affected by the following invariants: obs-6
                                                        BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                        (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason)

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

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        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()))
                                                        158. 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()))
                                                        160. 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()))
                                                        162. 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
                                                        BindingFor example codes, see SNOMEDCTBodyStructures
                                                        (example to http://hl7.org/fhir/ValueSet/body-site)

                                                        Codes describing anatomical locations. May include laterality.

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

                                                        Laboratory technigue that has been used

                                                        ShortHow it was done
                                                        Comments

                                                        Laboratory technique (method of measurement) are integral parts of the test specification of some laboratory test coding systems (e.g. NPU), in LOINC hovewer measurement principle is not always present in the test definition. In some cases however knowledge of the used measurment techique is important for proper interpretation of the test result. That's why it is important to explicitly include informaiton about measurement method is such cases.

                                                        Control0..1
                                                        BindingThe codes SHOULD be taken from Laboratory Techniques
                                                        (preferred to http://hl7.eu/fhir/laboratory/ValueSet/lab-technique-eu-lab)
                                                        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.

                                                        Pattern Value{
                                                          "coding" : [{
                                                            "system" : "http://snomed.info/sct",
                                                            "code" : "703505007",
                                                            "display" : "Clearance calculation relative to 1.73 square meters body surface area (qualifier value)"
                                                          }]
                                                        }
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        166. Observation.specimen
                                                        Definition

                                                        The specimen that was used when this observation was made.

                                                        ShortSpecimen used for this observation
                                                        Comments

                                                        When the specimen is applicable and known it shall be documented

                                                        Control0..1
                                                        TypeReference(CH LAB Specimen)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        168. Observation.device
                                                        Definition

                                                        The device used to generate the observation data.

                                                        ShortMeasuring instrument
                                                        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()))
                                                        170. 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.

                                                        Control1..3
                                                        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())
                                                        SlicingThis element introduces a set of slices on Observation.referenceRange. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ age.low.value
                                                        • 172. 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
                                                          174. 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())
                                                          176. 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())
                                                          178. 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()))
                                                          180. 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()))
                                                          182. 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()))
                                                          184. 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()))
                                                          186. 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()))
                                                          188. 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()))
                                                          190. Observation.referenceRange:child
                                                          Slice Namechild
                                                          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..1
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          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())
                                                          192. Observation.referenceRange:child.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
                                                          194. Observation.referenceRange:child.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())
                                                          196. Observation.referenceRange:child.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())
                                                          198. Observation.referenceRange:child.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()))
                                                          200. Observation.referenceRange:child.low.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
                                                          202. Observation.referenceRange:child.low.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.referenceRange.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 204. Observation.referenceRange:child.low.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).

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

                                                            Precision is handled implicitly in almost all cases of measurement.

                                                            Pattern Value90
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            206. Observation.referenceRange:child.low.comparator
                                                            Definition

                                                            Not allowed to be used in this context

                                                            Short< | <= | >= | > - how to understand the value
                                                            Control0..0
                                                            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()))
                                                            208. Observation.referenceRange:child.low.unit
                                                            Definition

                                                            A human-readable form of the unit.

                                                            ShortUnit representation
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            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.

                                                            Pattern ValuemL/min
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            210. Observation.referenceRange:child.low.system
                                                            Definition

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

                                                            ShortSystem that defines coded unit form
                                                            Control0..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
                                                            Summarytrue
                                                            Requirements

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

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

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

                                                            ShortCoded 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.

                                                            Control0..1
                                                            Typecode
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            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.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            214. Observation.referenceRange:child.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()))
                                                            216. Observation.referenceRange:child.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()))
                                                            218. Observation.referenceRange:child.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()))
                                                            220. Observation.referenceRange:child.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()))
                                                            222. Observation.referenceRange:child.age.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
                                                            224. Observation.referenceRange:child.age.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.referenceRange.age.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 226. Observation.referenceRange:child.age.low
                                                              Definition

                                                              The low limit. The boundary is inclusive.

                                                              ShortLow limit
                                                              Comments

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

                                                              Control0..1
                                                              TypeQuantity(SimpleQuantity)
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              228. Observation.referenceRange:child.age.low.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
                                                              230. Observation.referenceRange:child.age.low.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.referenceRange.age.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 232. Observation.referenceRange:child.age.low.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
                                                                Summarytrue
                                                                Requirements

                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                Pattern Value0
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                234. Observation.referenceRange:child.age.low.comparator
                                                                Definition

                                                                Not allowed to be used in this context

                                                                Short< | <= | >= | > - how to understand the value
                                                                Control0..0
                                                                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()))
                                                                236. Observation.referenceRange:child.age.low.unit
                                                                Definition

                                                                A human-readable form of the unit.

                                                                ShortUnit representation
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                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.

                                                                Pattern Valuea
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                238. Observation.referenceRange:child.age.low.system
                                                                Definition

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

                                                                ShortSystem that defines coded unit form
                                                                Control0..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
                                                                Summarytrue
                                                                Requirements

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

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

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

                                                                ShortCoded 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.

                                                                Control0..1
                                                                Typecode
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                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.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                242. Observation.referenceRange:child.age.high
                                                                Definition

                                                                The high limit. The boundary is inclusive.

                                                                ShortHigh limit
                                                                Comments

                                                                If the high element is missing, the high boundary is not known.

                                                                Control0..1
                                                                TypeQuantity(SimpleQuantity)
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                244. Observation.referenceRange:child.age.high.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
                                                                246. Observation.referenceRange:child.age.high.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.referenceRange.age.high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 248. Observation.referenceRange:child.age.high.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).

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

                                                                  Precision is handled implicitly in almost all cases of measurement.

                                                                  Pattern Value30
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  250. Observation.referenceRange:child.age.high.comparator
                                                                  Definition

                                                                  Not allowed to be used in this context

                                                                  Short< | <= | >= | > - how to understand the value
                                                                  Control0..0
                                                                  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()))
                                                                  252. Observation.referenceRange:child.age.high.unit
                                                                  Definition

                                                                  A human-readable form of the unit.

                                                                  ShortUnit representation
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  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.

                                                                  Pattern Valuea
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  254. Observation.referenceRange:child.age.high.system
                                                                  Definition

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

                                                                  ShortSystem that defines coded unit form
                                                                  Control0..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
                                                                  Summarytrue
                                                                  Requirements

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

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

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

                                                                  ShortCoded 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.

                                                                  Control0..1
                                                                  Typecode
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  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.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  258. Observation.referenceRange:child.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
                                                                  Pattern ValueDie Formel ist nur ab 18 Jahre validiert.
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  260. Observation.referenceRange:youth
                                                                  Slice Nameyouth
                                                                  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..1
                                                                  TypeBackboneElement
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  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())
                                                                  262. Observation.referenceRange:youth.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
                                                                  264. Observation.referenceRange:youth.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())
                                                                  266. Observation.referenceRange:youth.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())
                                                                  268. Observation.referenceRange:youth.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()))
                                                                  270. Observation.referenceRange:youth.low.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
                                                                  272. Observation.referenceRange:youth.low.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.referenceRange.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 274. Observation.referenceRange:youth.low.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).

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

                                                                    Precision is handled implicitly in almost all cases of measurement.

                                                                    Pattern Value90
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    276. Observation.referenceRange:youth.low.comparator
                                                                    Definition

                                                                    Not allowed to be used in this context

                                                                    Short< | <= | >= | > - how to understand the value
                                                                    Control0..0
                                                                    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()))
                                                                    278. Observation.referenceRange:youth.low.unit
                                                                    Definition

                                                                    A human-readable form of the unit.

                                                                    ShortUnit representation
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    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.

                                                                    Pattern ValuemL/min
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    280. Observation.referenceRange:youth.low.system
                                                                    Definition

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

                                                                    ShortSystem that defines coded unit form
                                                                    Control0..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
                                                                    Summarytrue
                                                                    Requirements

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

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

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

                                                                    ShortCoded 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.

                                                                    Control0..1
                                                                    Typecode
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    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.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    284. Observation.referenceRange:youth.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()))
                                                                    286. Observation.referenceRange:youth.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()))
                                                                    288. Observation.referenceRange:youth.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()))
                                                                    290. Observation.referenceRange:youth.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()))
                                                                    292. Observation.referenceRange:youth.age.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
                                                                    294. Observation.referenceRange:youth.age.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.referenceRange.age.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 296. Observation.referenceRange:youth.age.low
                                                                      Definition

                                                                      The low limit. The boundary is inclusive.

                                                                      ShortLow limit
                                                                      Comments

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

                                                                      Control0..1
                                                                      TypeQuantity(SimpleQuantity)
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      298. Observation.referenceRange:youth.age.low.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
                                                                      300. Observation.referenceRange:youth.age.low.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.referenceRange.age.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 302. Observation.referenceRange:youth.age.low.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
                                                                        Summarytrue
                                                                        Requirements

                                                                        Precision is handled implicitly in almost all cases of measurement.

                                                                        Pattern Value18
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        304. Observation.referenceRange:youth.age.low.comparator
                                                                        Definition

                                                                        Not allowed to be used in this context

                                                                        Short< | <= | >= | > - how to understand the value
                                                                        Control0..0
                                                                        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()))
                                                                        306. Observation.referenceRange:youth.age.low.unit
                                                                        Definition

                                                                        A human-readable form of the unit.

                                                                        ShortUnit representation
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        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.

                                                                        Pattern Valuea
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        308. Observation.referenceRange:youth.age.low.system
                                                                        Definition

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

                                                                        ShortSystem that defines coded unit form
                                                                        Control0..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
                                                                        Summarytrue
                                                                        Requirements

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

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

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

                                                                        ShortCoded 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.

                                                                        Control0..1
                                                                        Typecode
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        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.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        312. Observation.referenceRange:youth.age.high
                                                                        Definition

                                                                        The high limit. The boundary is inclusive.

                                                                        ShortHigh limit
                                                                        Comments

                                                                        If the high element is missing, the high boundary is not known.

                                                                        Control0..1
                                                                        TypeQuantity(SimpleQuantity)
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        314. Observation.referenceRange:youth.age.high.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
                                                                        316. Observation.referenceRange:youth.age.high.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.referenceRange.age.high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 318. Observation.referenceRange:youth.age.high.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).

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

                                                                          Precision is handled implicitly in almost all cases of measurement.

                                                                          Pattern Value30
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          320. Observation.referenceRange:youth.age.high.comparator
                                                                          Definition

                                                                          Not allowed to be used in this context

                                                                          Short< | <= | >= | > - how to understand the value
                                                                          Control0..0
                                                                          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()))
                                                                          322. Observation.referenceRange:youth.age.high.unit
                                                                          Definition

                                                                          A human-readable form of the unit.

                                                                          ShortUnit representation
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          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.

                                                                          Pattern Valuea
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          324. Observation.referenceRange:youth.age.high.system
                                                                          Definition

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

                                                                          ShortSystem that defines coded unit form
                                                                          Control0..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
                                                                          Summarytrue
                                                                          Requirements

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

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

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

                                                                          ShortCoded 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.

                                                                          Control0..1
                                                                          Typecode
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          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.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          328. Observation.referenceRange:youth.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
                                                                          Pattern ValueDie Formel ist ab 18 bis 93 Jahre validiert.
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          330. Observation.referenceRange:adult
                                                                          Slice Nameadult
                                                                          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..1
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          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())
                                                                          332. Observation.referenceRange:adult.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
                                                                          334. Observation.referenceRange:adult.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())
                                                                          336. Observation.referenceRange:adult.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())
                                                                          338. Observation.referenceRange:adult.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()))
                                                                          340. Observation.referenceRange:adult.low.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
                                                                          342. Observation.referenceRange:adult.low.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.referenceRange.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 344. Observation.referenceRange:adult.low.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).

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

                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                            Pattern Value60
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            346. Observation.referenceRange:adult.low.comparator
                                                                            Definition

                                                                            Not allowed to be used in this context

                                                                            Short< | <= | >= | > - how to understand the value
                                                                            Control0..0
                                                                            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()))
                                                                            348. Observation.referenceRange:adult.low.unit
                                                                            Definition

                                                                            A human-readable form of the unit.

                                                                            ShortUnit representation
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            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.

                                                                            Pattern ValuemL/min
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            350. Observation.referenceRange:adult.low.system
                                                                            Definition

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

                                                                            ShortSystem that defines coded unit form
                                                                            Control0..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
                                                                            Summarytrue
                                                                            Requirements

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

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

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

                                                                            ShortCoded 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.

                                                                            Control0..1
                                                                            Typecode
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            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.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            354. Observation.referenceRange:adult.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()))
                                                                            356. Observation.referenceRange:adult.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()))
                                                                            358. Observation.referenceRange:adult.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()))
                                                                            360. Observation.referenceRange:adult.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()))
                                                                            362. Observation.referenceRange:adult.age.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
                                                                            364. Observation.referenceRange:adult.age.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.referenceRange.age.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 366. Observation.referenceRange:adult.age.low
                                                                              Definition

                                                                              The low limit. The boundary is inclusive.

                                                                              ShortLow limit
                                                                              Comments

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

                                                                              Control0..1
                                                                              TypeQuantity(SimpleQuantity)
                                                                              Is Modifierfalse
                                                                              Summarytrue
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              368. Observation.referenceRange:adult.age.low.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
                                                                              370. Observation.referenceRange:adult.age.low.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.referenceRange.age.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 372. Observation.referenceRange:adult.age.low.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
                                                                                Summarytrue
                                                                                Requirements

                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                Pattern Value31
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                374. Observation.referenceRange:adult.age.low.comparator
                                                                                Definition

                                                                                Not allowed to be used in this context

                                                                                Short< | <= | >= | > - how to understand the value
                                                                                Control0..0
                                                                                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()))
                                                                                376. Observation.referenceRange:adult.age.low.unit
                                                                                Definition

                                                                                A human-readable form of the unit.

                                                                                ShortUnit representation
                                                                                Control0..1
                                                                                Typestring
                                                                                Is Modifierfalse
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                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.

                                                                                Pattern Valuea
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                378. Observation.referenceRange:adult.age.low.system
                                                                                Definition

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

                                                                                ShortSystem that defines coded unit form
                                                                                Control0..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
                                                                                Summarytrue
                                                                                Requirements

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

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

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

                                                                                ShortCoded 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.

                                                                                Control0..1
                                                                                Typecode
                                                                                Is Modifierfalse
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                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.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                382. Observation.referenceRange:adult.age.high
                                                                                Definition

                                                                                The high limit. The boundary is inclusive.

                                                                                ShortHigh limit
                                                                                Comments

                                                                                If the high element is missing, the high boundary is not known.

                                                                                Control0..1
                                                                                TypeQuantity(SimpleQuantity)
                                                                                Is Modifierfalse
                                                                                Summarytrue
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                384. Observation.referenceRange:adult.age.high.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
                                                                                386. Observation.referenceRange:adult.age.high.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.referenceRange.age.high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 388. Observation.referenceRange:adult.age.high.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).

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

                                                                                  Precision is handled implicitly in almost all cases of measurement.

                                                                                  Pattern Value100
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  390. Observation.referenceRange:adult.age.high.comparator
                                                                                  Definition

                                                                                  Not allowed to be used in this context

                                                                                  Short< | <= | >= | > - how to understand the value
                                                                                  Control0..0
                                                                                  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()))
                                                                                  392. Observation.referenceRange:adult.age.high.unit
                                                                                  Definition

                                                                                  A human-readable form of the unit.

                                                                                  ShortUnit representation
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  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.

                                                                                  Pattern Valuea
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  394. Observation.referenceRange:adult.age.high.system
                                                                                  Definition

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

                                                                                  ShortSystem that defines coded unit form
                                                                                  Control0..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
                                                                                  Summarytrue
                                                                                  Requirements

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

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

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

                                                                                  ShortCoded 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.

                                                                                  Control0..1
                                                                                  Typecode
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  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.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  398. Observation.referenceRange:adult.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
                                                                                  Pattern ValueDie Formel ist nur bis 93 Jahre validiert.
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  400. Observation.hasMember
                                                                                  Definition

                                                                                  A reference to another Observation profiled by ch-lab-observation-results-laboratory. The target observation (for instance an individual test member of a panel) is considered as a sub-observation of the current one, which plays the role of a grouper.

                                                                                  ShortRelated resource that belongs to the Observation group
                                                                                  Comments

                                                                                  This element is used in the context of international patient summary when there is a need to group a collection of observations, because they belong to the same panel, or because they share a common interpretation comment, or a common media attachment (illustrative image or graph). In these cases, the current observation is the grouper, and its set of sub-observations are related observations using the type "has-member". For a discussion on the ways Observations can be assembled in groups together see Observation Grouping.

                                                                                  Control0..0
                                                                                  TypeReference(CH LAB Observation Results: Laboratory Report)
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  402. 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, Observation, MolecularSequence)
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  404. Observation.component
                                                                                  Definition

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

                                                                                  ShortLaboratory result
                                                                                  Comments

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

                                                                                  Control2..2
                                                                                  TypeBackboneElement
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  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()))
                                                                                  SlicingThis element introduces a set of slices on Observation.component. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                  • value @ code
                                                                                  • 406. 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
                                                                                    408. Observation.component.extension
                                                                                    Definition

                                                                                    An Extension

                                                                                    ShortExtension
                                                                                    Control0..*
                                                                                    TypeExtension
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    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.component.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 410. Observation.component.extension:value-r5
                                                                                      Slice Namevalue-r5
                                                                                      Definition

                                                                                      Optional Extension Element - found in all resources.

                                                                                      Shortonly for result of type Attachment
                                                                                      Control0..1
                                                                                      This element is affected by the following invariants: ele-1
                                                                                      TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                                                                                      Is Modifierfalse
                                                                                      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())
                                                                                      412. Observation.component.extension:value-r5.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
                                                                                      414. Observation.component.extension:value-r5.extension
                                                                                      Definition

                                                                                      An Extension

                                                                                      ShortExtension
                                                                                      Control0..0
                                                                                      TypeExtension
                                                                                      Is Modifierfalse
                                                                                      Summaryfalse
                                                                                      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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 416. Observation.component.extension:value-r5.url
                                                                                        Definition

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

                                                                                        Shortidentifies the meaning of the extension
                                                                                        Comments

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

                                                                                        Control1..1
                                                                                        Typeuri
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                                                                                        418. Observation.component.extension:value-r5.value[x]
                                                                                        Definition

                                                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                        ShortValue of extension
                                                                                        Control1..1
                                                                                        TypeAttachment
                                                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        420. 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())
                                                                                        422. 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
                                                                                        BindingFor example codes, see LOINCCodes
                                                                                        (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                                        Codes identifying names of simple observations.

                                                                                        TypeCodeableConcept
                                                                                        Is Modifierfalse
                                                                                        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()))
                                                                                        424. Observation.component.value[x]
                                                                                        Definition

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

                                                                                        ShortActual component result
                                                                                        Comments

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

                                                                                        An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • type @ $this
                                                                                        • 426. Observation.component.value[x]:valueString
                                                                                          Slice NamevalueString
                                                                                          Definition

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

                                                                                          ShortActual 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.

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

                                                                                          An observation exists to have a value, though it 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()))
                                                                                          428. Observation.component.value[x]:valueRange
                                                                                          Slice NamevalueRange
                                                                                          Definition

                                                                                          A set of ordered Quantities defined by a low and high limit.

                                                                                          ShortSet of values bounded by low and high
                                                                                          Comments

                                                                                          The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: ele-1
                                                                                          TypeRange(Range (IPS))
                                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                          Is Modifierfalse
                                                                                          Requirements

                                                                                          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()))
                                                                                          rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                                                                                          430. Observation.component.value[x]:valueRatio
                                                                                          Slice NamevalueRatio
                                                                                          Definition

                                                                                          A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.

                                                                                          ShortA measured ratio using UCUM
                                                                                          Comments

                                                                                          The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.

                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: ele-1
                                                                                          TypeRatio(Ratio (Eu Lab))
                                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                          Is Modifierfalse
                                                                                          Requirements

                                                                                          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()))
                                                                                          rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                                                                                          432. Observation.component.value[x]:valueTime
                                                                                          Slice NamevalueTime
                                                                                          Definition

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

                                                                                          ShortActual 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.

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

                                                                                          An observation exists to have a value, though it 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()))
                                                                                          434. Observation.component.value[x]:valueDateTime
                                                                                          Slice NamevalueDateTime
                                                                                          Definition

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

                                                                                          ShortActual 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.

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

                                                                                          An observation exists to have a value, though it 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()))
                                                                                          436. Observation.component.value[x]:valuePeriod
                                                                                          Slice NamevaluePeriod
                                                                                          Definition

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

                                                                                          ShortActual 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.

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

                                                                                          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()))
                                                                                          438. Observation.component.value[x]:valueQuantity
                                                                                          Slice NamevalueQuantity
                                                                                          Definition

                                                                                          A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.

                                                                                          ShortA measured amount using UCUM
                                                                                          Comments

                                                                                          The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: ele-1
                                                                                          TypeQuantity(Quantity (Eu Lab))
                                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                          Is Modifierfalse
                                                                                          Requirements

                                                                                          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()))
                                                                                          qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                                                                          440. Observation.component.value[x]:valueCodeableConcept
                                                                                          Slice NamevalueCodeableConcept
                                                                                          Definition

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

                                                                                          ShortActual 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.

                                                                                          Control0..1
                                                                                          BindingThe codes SHOULD be taken from Results Coded Values Laboratory - IPS
                                                                                          (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                                                                                          Additional BindingsPurposeDocumentation
                                                                                          Results Blood Group - SNOMED CT IPS Free Setcandidate

                                                                                          Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                          Results Presence Absence - SNOMED CT IPS Free Setcandidate

                                                                                          Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                          Results Microorganism - SNOMED CT IPS Free Setcandidate

                                                                                          Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                                                                                          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()))
                                                                                          442. 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
                                                                                          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
                                                                                          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()))
                                                                                          444. 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()))
                                                                                          446. 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..*
                                                                                          TypeSee ttp://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()))
                                                                                          448. Observation.component:blacks
                                                                                          Slice Nameblacks
                                                                                          Definition

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

                                                                                          ShorteGFR_CKD_EPI among blacks
                                                                                          Comments

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

                                                                                          Control1..1
                                                                                          TypeBackboneElement
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          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()))
                                                                                          450. Observation.component:blacks.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
                                                                                          452. Observation.component:blacks.extension
                                                                                          Definition

                                                                                          An Extension

                                                                                          ShortExtension
                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          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.component.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                          • value @ url
                                                                                          • 454. Observation.component:blacks.extension:value-r5
                                                                                            Slice Namevalue-r5
                                                                                            Definition

                                                                                            An Extension

                                                                                            ShortExtension
                                                                                            Control0..1
                                                                                            This element is affected by the following invariants: ele-1
                                                                                            TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                                                                                            Is Modifierfalse
                                                                                            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())
                                                                                            456. Observation.component:blacks.extension:value-r5.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
                                                                                            458. Observation.component:blacks.extension:value-r5.extension
                                                                                            Definition

                                                                                            An Extension

                                                                                            ShortExtension
                                                                                            Control0..0
                                                                                            TypeExtension
                                                                                            Is Modifierfalse
                                                                                            Summaryfalse
                                                                                            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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                            • value @ url
                                                                                            • 460. Observation.component:blacks.extension:value-r5.url
                                                                                              Definition

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

                                                                                              Shortidentifies the meaning of the extension
                                                                                              Comments

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

                                                                                              Control1..1
                                                                                              Typeuri
                                                                                              Is Modifierfalse
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              Summaryfalse
                                                                                              Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                                                                                              462. Observation.component:blacks.extension:value-r5.value[x]
                                                                                              Definition

                                                                                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                              ShortValue of extension
                                                                                              Control1..1
                                                                                              TypeAttachment
                                                                                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                              Is Modifierfalse
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              464. Observation.component:blacks.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())
                                                                                              466. Observation.component:blacks.code
                                                                                              Definition

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

                                                                                              ShorteGFR_CKD_EPI among blacks code
                                                                                              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
                                                                                              BindingFor example codes, see LOINCCodes
                                                                                              (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                                              Codes identifying names of simple observations.

                                                                                              TypeCodeableConcept
                                                                                              Is Modifierfalse
                                                                                              Summarytrue
                                                                                              Requirements

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

                                                                                              Pattern Value{
                                                                                                "coding" : [{
                                                                                                  "system" : "http://loinc.org",
                                                                                                  "code" : "88293-6",
                                                                                                  "display" : "Glomerular filtration rate/1.73 sq M.predicted among blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
                                                                                                }]
                                                                                              }
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              468. Observation.component:blacks.value[x]
                                                                                              Definition

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

                                                                                              ShortActual 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.

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

                                                                                              An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                              • type @ $this
                                                                                              • 470. Observation.component:blacks.value[x]:valueQuantity
                                                                                                Slice NamevalueQuantity
                                                                                                Definition

                                                                                                A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.

                                                                                                ShortLab Result Component Value
                                                                                                Comments

                                                                                                The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

                                                                                                Control0..1
                                                                                                This element is affected by the following invariants: ele-1
                                                                                                TypeQuantity(Quantity (Eu Lab))
                                                                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                Is Modifierfalse
                                                                                                Must Supporttrue
                                                                                                Requirements

                                                                                                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()))
                                                                                                qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                                                                                472. Observation.component:blacks.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
                                                                                                474. Observation.component:blacks.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.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • value @ url
                                                                                                • 476. Observation.component:blacks.value[x]:valueQuantity.extension:uncertainty
                                                                                                  Slice Nameuncertainty
                                                                                                  Definition

                                                                                                  The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

                                                                                                  ShortStandard Deviation (same units as the quantity)
                                                                                                  Comments

                                                                                                  standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

                                                                                                  Control0..1
                                                                                                  TypeExtension(Uncertainty) (Extension Type: decimal)
                                                                                                  Is Modifierfalse
                                                                                                  Summaryfalse
                                                                                                  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())
                                                                                                  478. Observation.component:blacks.value[x]:valueQuantity.extension:uncertaintyType
                                                                                                  Slice NameuncertaintyType
                                                                                                  Definition

                                                                                                  A code specifying the type of probability distribution for the uncertainty.

                                                                                                  ShortProbability Distribution Type for uncertainty
                                                                                                  Comments

                                                                                                  This is only meaningful if there is also an uncertainty extension. If there is an uncertainty extension with no type, this means that the probability distribution type is unknown. In that case, the uncertainty has the meaning of an informal guess.

                                                                                                  Control0..1
                                                                                                  TypeExtension(Uncertainty type) (Extension Type: code)
                                                                                                  Is Modifierfalse
                                                                                                  Summaryfalse
                                                                                                  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())
                                                                                                  480. Observation.component:blacks.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
                                                                                                  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()))
                                                                                                  482. Observation.component:blacks.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()))
                                                                                                  484. Observation.component:blacks.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
                                                                                                  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()))
                                                                                                  486. Observation.component:blacks.value[x]:valueQuantity.system
                                                                                                  Definition

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

                                                                                                  ShortUCUM system for units
                                                                                                  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
                                                                                                  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()))
                                                                                                  488. Observation.component:blacks.value[x]:valueQuantity.code
                                                                                                  Definition

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

                                                                                                  ShortCoded 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.

                                                                                                  Control1..1
                                                                                                  Typecode
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  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 ValuemL/min
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  490. Observation.component:blacks.value[x]:valueString
                                                                                                  Slice NamevalueString
                                                                                                  Definition

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

                                                                                                  ShortActual 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.

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

                                                                                                  An observation exists to have a value, though it 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()))
                                                                                                  492. Observation.component:blacks.value[x]:valueRange
                                                                                                  Slice NamevalueRange
                                                                                                  Definition

                                                                                                  A set of ordered Quantities defined by a low and high limit.

                                                                                                  ShortSet of values bounded by low and high
                                                                                                  Comments

                                                                                                  The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

                                                                                                  Control0..1
                                                                                                  This element is affected by the following invariants: ele-1
                                                                                                  TypeRange(Range (IPS))
                                                                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                  Is Modifierfalse
                                                                                                  Requirements

                                                                                                  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()))
                                                                                                  rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                                                                                                  494. Observation.component:blacks.value[x]:valueRatio
                                                                                                  Slice NamevalueRatio
                                                                                                  Definition

                                                                                                  A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.

                                                                                                  ShortA measured ratio using UCUM
                                                                                                  Comments

                                                                                                  The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.

                                                                                                  Control0..1
                                                                                                  This element is affected by the following invariants: ele-1
                                                                                                  TypeRatio(Ratio (Eu Lab))
                                                                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                  Is Modifierfalse
                                                                                                  Requirements

                                                                                                  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()))
                                                                                                  rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                                                                                                  496. Observation.component:blacks.value[x]:valueTime
                                                                                                  Slice NamevalueTime
                                                                                                  Definition

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

                                                                                                  ShortActual 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.

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

                                                                                                  An observation exists to have a value, though it 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()))
                                                                                                  498. Observation.component:blacks.value[x]:valueDateTime
                                                                                                  Slice NamevalueDateTime
                                                                                                  Definition

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

                                                                                                  ShortActual 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.

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

                                                                                                  An observation exists to have a value, though it 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()))
                                                                                                  500. Observation.component:blacks.value[x]:valuePeriod
                                                                                                  Slice NamevaluePeriod
                                                                                                  Definition

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

                                                                                                  ShortActual 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.

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

                                                                                                  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()))
                                                                                                  502. Observation.component:blacks.value[x]:valueCodeableConcept
                                                                                                  Slice NamevalueCodeableConcept
                                                                                                  Definition

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

                                                                                                  ShortActual 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.

                                                                                                  Control0..1
                                                                                                  BindingThe codes SHOULD be taken from Results Coded Values Laboratory - IPS
                                                                                                  (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                                                                                                  Additional BindingsPurposeDocumentation
                                                                                                  Results Blood Group - SNOMED CT IPS Free Setcandidate

                                                                                                  Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                                  Results Presence Absence - SNOMED CT IPS Free Setcandidate

                                                                                                  Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                                  Results Microorganism - SNOMED CT IPS Free Setcandidate

                                                                                                  Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                                                                                                  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()))
                                                                                                  504. Observation.component:blacks.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
                                                                                                  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
                                                                                                  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()))
                                                                                                  506. Observation.component:blacks.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()))
                                                                                                  508. Observation.component:blacks.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..*
                                                                                                  TypeSee ttp://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()))
                                                                                                  510. Observation.component:non-blacks
                                                                                                  Slice Namenon-blacks
                                                                                                  Definition

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

                                                                                                  ShorteGFR_CKD_EPI among non-blacks
                                                                                                  Comments

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

                                                                                                  Control1..1
                                                                                                  TypeBackboneElement
                                                                                                  Is Modifierfalse
                                                                                                  Must Supporttrue
                                                                                                  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()))
                                                                                                  512. Observation.component:non-blacks.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
                                                                                                  514. Observation.component:non-blacks.extension
                                                                                                  Definition

                                                                                                  An Extension

                                                                                                  ShortExtension
                                                                                                  Control0..*
                                                                                                  TypeExtension
                                                                                                  Is Modifierfalse
                                                                                                  Summaryfalse
                                                                                                  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.component.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                  • value @ url
                                                                                                  • 516. Observation.component:non-blacks.extension:value-r5
                                                                                                    Slice Namevalue-r5
                                                                                                    Definition

                                                                                                    An Extension

                                                                                                    ShortExtension
                                                                                                    Control0..1
                                                                                                    This element is affected by the following invariants: ele-1
                                                                                                    TypeExtension(Extension Definition for Observation.value[x] for Version 5.0) (Extension Type: Choice of: Attachment, Reference(MolecularSequence))
                                                                                                    Is Modifierfalse
                                                                                                    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())
                                                                                                    518. Observation.component:non-blacks.extension:value-r5.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
                                                                                                    520. Observation.component:non-blacks.extension:value-r5.extension
                                                                                                    Definition

                                                                                                    An Extension

                                                                                                    ShortExtension
                                                                                                    Control0..0
                                                                                                    TypeExtension
                                                                                                    Is Modifierfalse
                                                                                                    Summaryfalse
                                                                                                    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.component.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                    • value @ url
                                                                                                    • 522. Observation.component:non-blacks.extension:value-r5.url
                                                                                                      Definition

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

                                                                                                      Shortidentifies the meaning of the extension
                                                                                                      Comments

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

                                                                                                      Control1..1
                                                                                                      Typeuri
                                                                                                      Is Modifierfalse
                                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                      Summaryfalse
                                                                                                      Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.value[x]
                                                                                                      524. Observation.component:non-blacks.extension:value-r5.value[x]
                                                                                                      Definition

                                                                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                                                                      ShortValue of extension
                                                                                                      Control1..1
                                                                                                      TypeAttachment
                                                                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                      Is Modifierfalse
                                                                                                      Summaryfalse
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      526. Observation.component:non-blacks.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())
                                                                                                      528. Observation.component:non-blacks.code
                                                                                                      Definition

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

                                                                                                      ShorteGFR_CKD_EPI among non-blacks code
                                                                                                      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
                                                                                                      BindingFor example codes, see LOINCCodes
                                                                                                      (example to http://hl7.org/fhir/ValueSet/observation-codes)

                                                                                                      Codes identifying names of simple observations.

                                                                                                      TypeCodeableConcept
                                                                                                      Is Modifierfalse
                                                                                                      Summarytrue
                                                                                                      Requirements

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

                                                                                                      Pattern Value{
                                                                                                        "coding" : [{
                                                                                                          "system" : "http://loinc.org",
                                                                                                          "code" : "88294-4",
                                                                                                          "display" : "Glomerular filtration rate/1.73 sq M.predicted among non-blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI)"
                                                                                                        }]
                                                                                                      }
                                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                      530. Observation.component:non-blacks.value[x]
                                                                                                      Definition

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

                                                                                                      ShortActual 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.

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

                                                                                                      An observation exists to have a value, though it 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.component.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                                      • type @ $this
                                                                                                      • 532. Observation.component:non-blacks.value[x]:valueQuantity
                                                                                                        Slice NamevalueQuantity
                                                                                                        Definition

                                                                                                        A measured amount (or an amount that can potentially be measured) and uncertainty of the measurement. Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies. This profile imposes that the code system for units be UCUM.

                                                                                                        ShortLab Result Component Value
                                                                                                        Comments

                                                                                                        The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

                                                                                                        Control0..1
                                                                                                        This element is affected by the following invariants: ele-1
                                                                                                        TypeQuantity(Quantity (Eu Lab))
                                                                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                        Is Modifierfalse
                                                                                                        Must Supporttrue
                                                                                                        Requirements

                                                                                                        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()))
                                                                                                        qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                                                                                        534. Observation.component:non-blacks.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
                                                                                                        536. Observation.component:non-blacks.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.component.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                        • value @ url
                                                                                                        • 538. Observation.component:non-blacks.value[x]:valueQuantity.extension:uncertainty
                                                                                                          Slice Nameuncertainty
                                                                                                          Definition

                                                                                                          The primary measure of variance/uncertainty of the value (the square root of the sum of the squares of the differences between all data points and the mean).

                                                                                                          ShortStandard Deviation (same units as the quantity)
                                                                                                          Comments

                                                                                                          standardDeviation has the same units as the quantity. It is used to normalize the data for computing the distribution function. Applications that cannot deal with probability distributions can still get an idea about the confidence level by looking at standardDeviation.

                                                                                                          Control0..1
                                                                                                          TypeExtension(Uncertainty) (Extension Type: decimal)
                                                                                                          Is Modifierfalse
                                                                                                          Summaryfalse
                                                                                                          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())
                                                                                                          540. Observation.component:non-blacks.value[x]:valueQuantity.extension:uncertaintyType
                                                                                                          Slice NameuncertaintyType
                                                                                                          Definition

                                                                                                          A code specifying the type of probability distribution for the uncertainty.

                                                                                                          ShortProbability Distribution Type for uncertainty
                                                                                                          Comments

                                                                                                          This is only meaningful if there is also an uncertainty extension. If there is an uncertainty extension with no type, this means that the probability distribution type is unknown. In that case, the uncertainty has the meaning of an informal guess.

                                                                                                          Control0..1
                                                                                                          TypeExtension(Uncertainty type) (Extension Type: code)
                                                                                                          Is Modifierfalse
                                                                                                          Summaryfalse
                                                                                                          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())
                                                                                                          542. Observation.component:non-blacks.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
                                                                                                          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()))
                                                                                                          544. Observation.component:non-blacks.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()))
                                                                                                          546. Observation.component:non-blacks.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
                                                                                                          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()))
                                                                                                          548. Observation.component:non-blacks.value[x]:valueQuantity.system
                                                                                                          Definition

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

                                                                                                          ShortUCUM system for units
                                                                                                          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
                                                                                                          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()))
                                                                                                          550. Observation.component:non-blacks.value[x]:valueQuantity.code
                                                                                                          Definition

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

                                                                                                          ShortCoded 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.

                                                                                                          Control1..1
                                                                                                          Typecode
                                                                                                          Is Modifierfalse
                                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                          Must Supporttrue
                                                                                                          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 ValuemL/min
                                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                          552. Observation.component:non-blacks.value[x]:valueString
                                                                                                          Slice NamevalueString
                                                                                                          Definition

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

                                                                                                          ShortActual 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.

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

                                                                                                          An observation exists to have a value, though it 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()))
                                                                                                          554. Observation.component:non-blacks.value[x]:valueRange
                                                                                                          Slice NamevalueRange
                                                                                                          Definition

                                                                                                          A set of ordered Quantities defined by a low and high limit.

                                                                                                          ShortSet of values bounded by low and high
                                                                                                          Comments

                                                                                                          The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

                                                                                                          Control0..1
                                                                                                          This element is affected by the following invariants: ele-1
                                                                                                          TypeRange(Range (IPS))
                                                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                          Is Modifierfalse
                                                                                                          Requirements

                                                                                                          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()))
                                                                                                          rng-2: If present, low SHALL have a lower value than high (low.empty() or high.empty() or (low <= high))
                                                                                                          556. Observation.component:non-blacks.value[x]:valueRatio
                                                                                                          Slice NamevalueRatio
                                                                                                          Definition

                                                                                                          A measured ratio (or a ratio that can potentially be measured) and uncertainty of the measurement. This profile imposes that the code system for units be UCUM.

                                                                                                          ShortA measured ratio using UCUM
                                                                                                          Comments

                                                                                                          The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.

                                                                                                          Control0..1
                                                                                                          This element is affected by the following invariants: ele-1
                                                                                                          TypeRatio(Ratio (Eu Lab))
                                                                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                                                          Is Modifierfalse
                                                                                                          Requirements

                                                                                                          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()))
                                                                                                          rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present ((numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()))
                                                                                                          558. Observation.component:non-blacks.value[x]:valueTime
                                                                                                          Slice NamevalueTime
                                                                                                          Definition

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

                                                                                                          ShortActual 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.

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

                                                                                                          An observation exists to have a value, though it 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()))
                                                                                                          560. Observation.component:non-blacks.value[x]:valueDateTime
                                                                                                          Slice NamevalueDateTime
                                                                                                          Definition

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

                                                                                                          ShortActual 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.

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

                                                                                                          An observation exists to have a value, though it 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()))
                                                                                                          562. Observation.component:non-blacks.value[x]:valuePeriod
                                                                                                          Slice NamevaluePeriod
                                                                                                          Definition

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

                                                                                                          ShortActual 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.

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

                                                                                                          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()))
                                                                                                          564. Observation.component:non-blacks.value[x]:valueCodeableConcept
                                                                                                          Slice NamevalueCodeableConcept
                                                                                                          Definition

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

                                                                                                          ShortActual 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.

                                                                                                          Control0..1
                                                                                                          BindingThe codes SHOULD be taken from Results Coded Values Laboratory - IPS
                                                                                                          (preferred to http://hl7.org/fhir/uv/ips/ValueSet/results-coded-values-laboratory-uv-ips)
                                                                                                          Additional BindingsPurposeDocumentation
                                                                                                          Results Blood Group - SNOMED CT IPS Free Setcandidate

                                                                                                          Additional conformance binding to a blood group findings value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                                          Results Presence Absence - SNOMED CT IPS Free Setcandidate

                                                                                                          Additional conformance binding to a presence and absence findings (qualifier values) value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

                                                                                                          Results Microorganism - SNOMED CT IPS Free Setcandidate

                                                                                                          Additional conformance binding to a microorganisms value set for laboratory result values from the SNOMED CT IPS free set for use globally (in SNOMED member and non-member jurisdictions).

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

                                                                                                          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()))
                                                                                                          566. Observation.component:non-blacks.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
                                                                                                          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
                                                                                                          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()))
                                                                                                          568. Observation.component:non-blacks.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()))
                                                                                                          570. Observation.component:non-blacks.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..*
                                                                                                          TypeSee ttp://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()))