Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a patient's care experience preferences.
• Record or update clinical observations or assessments about a patient's care experience preferences.

Mandatory and Must Support Data Elements

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.

Each Observation Must Have:

1. a status
2. a fixed code for care experience preference
3. a patient

Each Observation Must Support:

1. a category code of "care-experience-preference"
2. a time indicating when the preference was made
3. care experience preference value

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the Observation examples.

1. a performer¹

¹ see guidance below

Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

• Care experience preferences expressed by a patient might be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.
• The context or precondition of a patient's preference SHOULD be supplied in:
  • the Observation.valueString (for example, "If this [health scenario] were to occur, …”) or
  • an extension such as the PACIO Advance Directive Interoperability Implementation Guide's Enclosed Precondition Extension.^§
• 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 , for example, the more specific LOINC, "81364-2 (Religious or cultural beliefs [Reported])"

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

  • See the existing Care Experience Preferences at End of Life Grouping for more specific concepts representing an individual's care experience preferences

• ¹The profile elements Observation.performer and Observation.device communicate the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

Changes since version 9.0.0:

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	US Core Care Experience Preference Profile Constraints: obs-6, obs-7
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer	Σ This element is included in summaries.	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	Observation	US Core Care Experience Preference Profile
Observation.status	S This element must be supported.	1..1	code	registered | preliminary | final | amended +
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported.	1..1	CodeableConcept	Care experience preferences code Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer		0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported.	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	US Core Care Experience Preference Profile Constraints: obs-6, obs-7
Observation.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Observation.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Observation.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Observation.contained		0..*	Resource	Contained, inline Resources
Observation.extension		0..*	Extension	Additional content defined by implementations
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for observation
Observation.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
Observation.partOf	Σ This element is included in summaries.	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.focus	Σ This element is included in summaries.	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
Observation.encounter	Σ This element is included in summaries.	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.issued	Σ This element is included in summaries.	0..1	instant	Date/Time this version was made available
Observation.performer	Σ This element is included in summaries.	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Observation.dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.note		0..*	Annotation	Comments about the observation
Observation.bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Observation.method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
Observation.specimen		0..1	Reference(Specimen)	Specimen used for this observation
Observation.device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
Observation.referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
Observation.referenceRange.id		0..1	string	Unique id for inter-element referencing
Observation.referenceRange.extension		0..*	Extension	Additional content defined by implementations
Observation.referenceRange.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant Constraints: sqty-1
Observation.referenceRange.high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant Constraints: sqty-1
Observation.referenceRange.type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age		0..1	Range	Applicable age range, if relevant
Observation.referenceRange.text		0..1	string	Text based reference range in an observation
Observation.hasMember	Σ This element is included in summaries.	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
Observation.derivedFrom	Σ This element is included in summaries.	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
Observation.component	Σ This element is included in summaries.	0..*	BackboneElement	Component results
Observation.component.id		0..1	string	Unique id for inter-element referencing
Observation.component.extension		0..*	Extension	Additional content defined by implementations
Observation.component.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.component.code	Σ This element is included in summaries.	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
Observation.component.value[x]	Σ This element is included in summaries.	0..1		Actual component result
Observation.component.value[x].valueQuantity			Quantity
Observation.component.value[x].valueCodeableConcept			CodeableConcept
Observation.component.value[x].valueString			string
Observation.component.value[x].valueBoolean			boolean
Observation.component.value[x].valueInteger			integer
Observation.component.value[x].valueRange			Range
Observation.component.value[x].valueRatio			Ratio
Observation.component.value[x].valueSampledData			SampledData
Observation.component.value[x].valueTime			time
Observation.component.value[x].valueDateTime			dateTime
Observation.component.value[x].valuePeriod			Period
Observation.component.dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.component.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.component.referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	US Core Care Experience Preference Profile Constraints: obs-6, obs-7
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer	Σ This element is included in summaries.	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	Observation	US Core Care Experience Preference Profile
Observation.status	S This element must be supported.	1..1	code	registered | preliminary | final | amended +
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported.	1..1	CodeableConcept	Care experience preferences code Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer		0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported.	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	US Core Care Experience Preference Profile Constraints: obs-6, obs-7
Observation.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Observation.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Observation.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Observation.contained		0..*	Resource	Contained, inline Resources
Observation.extension		0..*	Extension	Additional content defined by implementations
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for observation
Observation.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
Observation.partOf	Σ This element is included in summaries.	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Observation.Slices for category	S This element must be supported.	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core	S This element must be supported.	0..1	CodeableConcept	Classification of type of observation Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories. Required Pattern: { "coding" : [ { "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category", "code" : "care-experience-preference" } ] }
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: { "coding" : [ { "system" : "http://loinc.org", "code" : "95541-9" } ] }
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Observation.focus	Σ This element is included in summaries.	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
Observation.encounter	Σ This element is included in summaries.	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.issued	Σ This element is included in summaries.	0..1	instant	Date/Time this version was made available
Observation.performer	Σ This element is included in summaries.	0..*	Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result
Observation.value[x].valueString			string S This target must be supported.
Observation.value[x].valueCodeableConcept			CodeableConcept S This type must be supported.
Observation.value[x].valueQuantity			Quantity
Observation.value[x].valueBoolean			boolean
Observation.value[x].valueInteger			integer
Observation.value[x].valueRange			Range
Observation.value[x].valueRatio			Ratio
Observation.value[x].valueSampledData			SampledData
Observation.value[x].valueTime			time
Observation.value[x].valueDateTime			dateTime
Observation.value[x].valuePeriod			Period
Observation.dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.note		0..*	Annotation	Comments about the observation
Observation.bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Observation.method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
Observation.specimen		0..1	Reference(Specimen)	Specimen used for this observation
Observation.device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
Observation.referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
Observation.referenceRange.id		0..1	string	Unique id for inter-element referencing
Observation.referenceRange.extension		0..*	Extension	Additional content defined by implementations
Observation.referenceRange.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant Constraints: sqty-1
Observation.referenceRange.high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant Constraints: sqty-1
Observation.referenceRange.type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age		0..1	Range	Applicable age range, if relevant
Observation.referenceRange.text		0..1	string	Text based reference range in an observation
Observation.hasMember	Σ This element is included in summaries.	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
Observation.derivedFrom	Σ This element is included in summaries.	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
Observation.component	Σ This element is included in summaries.	0..*	BackboneElement	Component results
Observation.component.id		0..1	string	Unique id for inter-element referencing
Observation.component.extension		0..*	Extension	Additional content defined by implementations
Observation.component.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.component.code	Σ This element is included in summaries.	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
Observation.component.value[x]	Σ This element is included in summaries.	0..1		Actual component result
Observation.component.value[x].valueQuantity			Quantity
Observation.component.value[x].valueCodeableConcept			CodeableConcept
Observation.component.value[x].valueString			string
Observation.component.value[x].valueBoolean			boolean
Observation.component.value[x].valueInteger			integer
Observation.component.value[x].valueRange			Range
Observation.component.value[x].valueRatio			Ratio
Observation.component.value[x].valueSampledData			SampledData
Observation.component.value[x].valueTime			time
Observation.component.value[x].valueDateTime			dateTime
Observation.component.value[x].valuePeriod			Period
Observation.component.dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.component.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.component.referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.category:us-core	Base	preferred	US Core Simple Observation Category	📦10.0.0-ballot	This IG
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Observation

Summary

Mandatory: 1 element
Must-Support: 7 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Observation.category

Maturity: 2

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 care experience preference data SHALL support these US Core SMART Scopes:

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

Servers providing access to care experience preference data MAY support these US Core SMART Scopes:

• granular scopes: <patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|care-experience-preference ^[§][]

Mandatory Search Parameters:

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

1. SHALL support searching for all Observations using the combination of the patient and category search parameters

   GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&category=care-experience-preference

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and a category code = "care-experience-preference" ( see how to search by reference and how to search by token).

2. SHALL support searching for all Observations by code using the combination of the patient and code search parameters

   • Including optional support OR search on code (e.g.code={system|}[code],{system|}[code],...)

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

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|95541-9

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The US Core Care Experience Preference Profile "code" parameter searches only .code and not component.code. ( see how to search by reference and how to search by token).

3. SHALL support searching for all Observations by date (for example, results after 2018) using the combination of the patient and category and date search parameters

   • Including optional support for AND search on date (e.g.date=[date]&date=[date]&...)

   • Including support for these date comparators: "gt", "lt", "ge", "le"

   GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&category=care-experience-preference&date=ge2018-03-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and date and a category code = "care-experience-preference" ( see how to search by reference and how to search by token and how to search by date).

Optional Search Parameters:

The following search parameters and search parameter combinations SHOULD be supported

1. SHOULD support searching for all Observations for a patient for a given status (for example all observations marked as final) using the combination of the patient and category and status search parameters

   • Including support OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&status={system|}[search_code]{,{system|}[code],...}

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&category=care-experience-preference&status=final

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and category = "care-experience-preference" and status ( see 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 optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]&...)

   • Including support for these _lastUpdated comparators: "gt", "lt", "ge", "le"

   GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&_lastUpdated=[dateTime]

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&category=care-experience-preference&_lastUpdated=ge2024-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and category code = "care-experience-preference" and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. ( see how to search by reference and how to search by token and how to search by date).

3. SHOULD support searching Observations by code and date using the combination of the patient and code and date search parameters

   • Including optional support OR search on code (e.g.code={system|}[code],{system|}[code],...)

   • Including optional support for AND search on date (e.g.date=[date]&date=[date]&...)

   • Including support for these date comparators: "gt", "lt", "ge", "le"

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

   Example:

   1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|95541-9&date=ge2019-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Care Experience Preference Profile resources for the specified patient and date and code(s). SHOULD support search by multiple codes. ( see how to search by reference and how to search by token and how to search by date).