US Core Implementation Guide
8.0.0-ballot - Ballot United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core Pediatric BMI for Age Observation Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCorePediatricBMIforAgeObservationProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.2

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Pediatric BMI for Age Observation Profile inherits from the US Core Vital Signs Profile. This profile sets minimum expectations for the Observation resource to record, search, and fetch pediatric body mass index (BMI) percentile per age and sex for youth 2-20 observations in FHIR using a standard LOINC code and UCUM units of measure. It specifies which additional core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for BMI observations belonging to a pediatric patient
  • Record or update BMI observations belonging to a pediatric patient

Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the US Core Vital Signs Profile, the following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.
Note that the "Differential Table" displays elements unique to this profile and the "Key Elements Table” displays a combined view of elements for this profile and the US Core Vital Signs Profile.

Each Observation Must Have:

  1. a patient
  2. a fixed code for pediatric BMI per age and gender measurement

Each Observation Must Support:

  1. a result value

Profile Specific Implementation Guidance:

  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local system-specific code
    • providing more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.

    A code system value SHOULD be supplied for each additional code.

  • The observations MAY have component observations. For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.
  • *An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.
    • For further guidance, see the Observation Grouping section in FHIR Specification.
    • Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
  • *An Observation.component without a value, SHALL include a reason why the data is absent.
    • Systems that never provide a component observation without a component value are not required to support Observation.component.dataAbsentReason.

  • Implementers may use this profile as a base for other vital signs in addition to those in this guide.

  • Information about the growth chart tables used to determine percentiles SHOULD be supplied in Observation.note.text (for example, 'CDC Males, 2-20 years Chart').

Usage:

Changes since version 7.0.0:

  • No changes

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    This structure is derived from USCoreVitalSignsProfile

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    ... code S 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ... valueQuantity S 0..1 Quantity S Vital Signs Value
    .... value S 1..1 decimal Numerical value (with implicit precision)
    .... unit S 1..1 string Unit representation
    .... system S 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    .... code S 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %

    doco Documentation for this format
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    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
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ... code SΣ 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... Slices for value[x] SΣC 0..1 Vital Signs Value
    Slice: Unordered, Open by type:$this
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity
    .... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... value SΣ 1..1 decimal Numerical value (with implicit precision)
    ..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
    Binding: QuantityComparator (required): How the Quantity should be understood and represented.

    ..... unit SΣ 1..1 string Unit representation
    ..... system SΣC 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    ..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensiblePattern: LOINC Code 59576-9
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantityextensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
    http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    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
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... version Σ 0..1 string Version of the system - if relevant
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ...... display Σ 0..1 string Representation defined by the system
    ...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
    ..... text Σ 0..1 string Plain text representation of the concept
    ... code SΣ 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... Slices for value[x] SΣC 0..1 Vital Signs Value
    Slice: Unordered, Open by type:$this
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    .... value[x]:valueQuantity SΣC 0..1 Quantity S Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... value SΣ 1..1 decimal Numerical value (with implicit precision)
    ..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
    Binding: QuantityComparator (required): How the Quantity should be understood and represented.

    ..... unit SΣ 1..1 string Unit representation
    ..... system SΣC 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    ..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Observed body part
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensiblePattern: LOINC Code 59576-9
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantityextensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
    http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

    This structure is derived from USCoreVitalSignsProfile

    Summary

    Mandatory: 0 element(4 nested mandatory elements)
    Must-Support: 6 elements
    Fixed: 2 elements

    Maturity: 3

    Differential View

    This structure is derived from USCoreVitalSignsProfile

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    ... code S 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ... valueQuantity S 0..1 Quantity S Vital Signs Value
    .... value S 1..1 decimal Numerical value (with implicit precision)
    .... unit S 1..1 string Unit representation
    .... system S 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    .... code S 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %

    doco Documentation for this format

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    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
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ... code SΣ 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... Slices for value[x] SΣC 0..1 Vital Signs Value
    Slice: Unordered, Open by type:$this
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity
    .... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... value SΣ 1..1 decimal Numerical value (with implicit precision)
    ..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
    Binding: QuantityComparator (required): How the Quantity should be understood and represented.

    ..... unit SΣ 1..1 string Unit representation
    ..... system SΣC 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    ..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensiblePattern: LOINC Code 59576-9
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantityextensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
    http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Observation C 0..* USCoreVitalSignsProfile US Core Pediatric BMI for Age Observation Profile
    obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    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
    vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier Business Identifier for observation
    ... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
    ... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
    ... status ?!SΣ 1..1 code registered | preliminary | final | amended +
    Binding: ObservationStatus (required)
    ... Slices for category S 1..* CodeableConcept Classification of type of observation
    Slice: Unordered, Open by value:coding.code, value:coding.system
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    .... category:VSCat S 1..1 CodeableConcept Classification of type of observation
    Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding SΣ 1..* Coding Code defined by a terminology system
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ...... system SΣ 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
    ...... version Σ 0..1 string Version of the system - if relevant
    ...... code SΣ 1..1 code Symbol in syntax defined by the system
    Fixed Value: vital-signs
    ...... display Σ 0..1 string Representation defined by the system
    ...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
    ..... text Σ 0..1 string Plain text representation of the concept
    ... code SΣ 1..1 CodeableConcept BMI percentile per age and sex for youth 2-20
    Binding: Vital Sign Result Type . (extensible): Vital sign result types


    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://loinc.org
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: 59576-9
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
    ... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
    ... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
    ... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
    vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
    .... effectiveDateTime dateTime S
    .... effectivePeriod Period
    ... issued Σ 0..1 instant Date/Time this version was made available
    ... performer SΣ 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
    ... Slices for value[x] SΣC 0..1 Vital Signs Value
    Slice: Unordered, Open by type:$this
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    .... valueQuantity Quantity S
    .... valueCodeableConcept CodeableConcept
    .... valueString string
    .... valueBoolean boolean
    .... valueInteger integer
    .... valueRange Range
    .... valueRatio Ratio
    .... valueSampledData SampledData
    .... valueTime time
    .... valueDateTime dateTime
    .... valuePeriod Period
    .... value[x]:valueQuantity SΣC 0..1 Quantity S Vital Signs Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... value SΣ 1..1 decimal Numerical value (with implicit precision)
    ..... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
    Binding: QuantityComparator (required): How the Quantity should be understood and represented.

    ..... unit SΣ 1..1 string Unit representation
    ..... system SΣC 1..1 uri System that defines coded unit form
    Fixed Value: http://unitsofmeasure.org
    ..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
    Fixed Value: %
    ... dataAbsentReason SC 0..1 CodeableConcept Why the result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    ... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    ... note 0..* Annotation Comments about the observation
    ... bodySite 0..1 CodeableConcept Observed body part
    Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

    ... method 0..1 CodeableConcept How it was done
    Binding: ObservationMethods (example): Methods for simple observations.

    ... specimen 0..1 Reference(Specimen) Specimen used for this observation
    ... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
    ... referenceRange C 0..* BackboneElement Provides guide for interpretation
    obs-3: Must have at least a low or a high or text
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... low C 0..1 SimpleQuantity Low Range, if relevant
    .... high C 0..1 SimpleQuantity High Range, if relevant
    .... type 0..1 CodeableConcept Reference range qualifier
    Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

    .... appliesTo 0..* CodeableConcept Reference range population
    Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


    .... age 0..1 Range Applicable age range, if relevant
    .... text 0..1 string Text based reference range in an observation
    ... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Used when reporting vital signs panel components
    ... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) Related measurements the observation is made from
    ... component SΣC 0..* BackboneElement Component observations
    vs-3: If there is no a value a data absent reason must be present
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... code SΣ 1..1 CodeableConcept Coded vital sign result type
    Binding: Vital Sign Result Type . (extensible): Vital sign result types

    .... value[x] SΣC 0..1 Vital Sign Component Value
    Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

    ..... valueQuantity Quantity S
    ..... valueCodeableConcept CodeableConcept
    ..... valueString string
    ..... valueBoolean boolean
    ..... valueInteger integer
    ..... valueRange Range
    ..... valueRatio Ratio
    ..... valueSampledData SampledData
    ..... valueTime time
    ..... valueDateTime dateTime
    ..... valuePeriod Period
    .... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
    Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

    .... interpretation 0..* CodeableConcept High, low, normal, etc.
    Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


    .... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Observation.statusrequiredObservationStatus
    http://hl7.org/fhir/ValueSet/observation-status|4.0.1
    from the FHIR Standard
    Observation.categorypreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.category:VSCatpreferredObservationCategoryCodes
    http://hl7.org/fhir/ValueSet/observation-category
    from the FHIR Standard
    Observation.codeextensiblePattern: LOINC Code 59576-9
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantityextensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
    http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
    from the FHIR Standard
    Observation.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard
    Observation.bodySiteexampleSNOMEDCTBodyStructures
    http://hl7.org/fhir/ValueSet/body-site
    from the FHIR Standard
    Observation.methodexampleObservationMethods
    http://hl7.org/fhir/ValueSet/observation-methods
    from the FHIR Standard
    Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
    http://hl7.org/fhir/ValueSet/referencerange-meaning
    from the FHIR Standard
    Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
    http://hl7.org/fhir/ValueSet/referencerange-appliesto
    from the FHIR Standard
    Observation.component.codeextensibleVitalSignResultType .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62
    Observation.component.value[x]extensibleVitalSignsUnits
    http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
    from the FHIR Standard
    Observation.component.dataAbsentReasonextensibleDataAbsentReason
    http://hl7.org/fhir/ValueSet/data-absent-reason
    from the FHIR Standard
    Observation.component.interpretationextensibleObservationInterpretationCodes
    http://hl7.org/fhir/ValueSet/observation-interpretation
    from the FHIR Standard

    This structure is derived from USCoreVitalSignsProfile

    Summary

    Mandatory: 0 element(4 nested mandatory elements)
    Must-Support: 6 elements
    Fixed: 2 elements

    Maturity: 3

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    ​Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to vital signs data SHALL support these US Core SMART Scopes:

    • resource level scopes: <patient|user|system>/Observation.rs

    • granular scopes: <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the combination of the patient and category search parameters:

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = vital-signs (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and code search parameters:
      • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=1186747&code=http://loinc.org|29463-7,http://loinc.org|8302-2,http://loinc.org|59576-9

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)

    3. SHALL support searching using the combination of the patient and category and date search parameters:
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = vital-signs (how to search by reference and how to search by token and how to search by date)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and category and status search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and category and _lastUpdated search parameters:
      • including support for these _lastUpdated comparators: gt,lt,ge,le
      • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)

    3. SHOULD support searching using the combination of the patient and code and date search parameters:
      • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Observation?patient=1186747&code=http://loinc.org|29463-7,http://loinc.org|8302-2,http://loinc.org|59576-9&date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)