Observation - APGAR Score - Birth And Fetal Death (BFDR) FHIR Implementation Guide v2.0.0

Birth And Fetal Death (BFDR) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-bfdr/ and changes regularly. See the Directory of published versions

Resource Profile: Observation - APGAR Score

Official URL: http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-apgar-score	Version: 2.0.0	Highlight text changes?
Standards status: Draft		Computable Name: ObservationApgarScore
Other Identifiers: OID:2.16.840.1.113883.4.642.40.13.42.34

APGAR score post-birth.

Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings.

IJE Mapping

Use Case	#	Description	IJE Name	Field	Type	Value Set/Comments
Natality	205	Apgar Score at 5 Minutes	APGAR5	value, code = 9274-2 (5 minute Apgar Score)	integer
Natality	206	Apgar Score at 10 Minutes	APGAR10	value, code = 9271-8 (10 minute Apgar Score)	integer

Use Case

Description

IJE Name

Field

Type

Value Set/Comments

Natality

205

Apgar Score at 5 Minutes

APGAR5

value,
code = 9274-2 (5 minute Apgar Score)

integer

Natality

206

Apgar Score at 10 Minutes

APGAR10

value,
code = 9271-8 (10 minute Apgar Score)

integer

Form Mapping

Item #	Form Field	FHIR Profile Field	Reference
51	Apgar Score	value	Certificate of Live Birth
32	Apgar score	value	Facility Worksheet for the Live Birth Certificate
32	Apgar score	value	Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births

Item #

Form Field

FHIR Profile Field

Reference

Apgar Score

value

Certificate of Live Birth

Apgar score

value

Facility Worksheet for the Live Birth Certificate

Apgar score

value

Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births

Usages:

Refer to this Profile: Composition - Jurisdiction Live Birth Report and Composition - Provider Live Birth Report
Examples for this Profile: Observation/observation-apgar-score-babyg-quinn-10-min and Observation/observation-apgar-score-babyg-quinn-5-min

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreObservationSurveyProfile	Survey Observation Constraints: obs-6, obs-7, us-core-2, us-core-3
Observation.implicitRules	This element is a modifier element. 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. This element must be supported. 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	This element must be supported.	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): 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:survey	This element must be supported.	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/observation-category", "code" : "survey" } ] }`
Observation.code	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Standard timings for APGAR assessments. Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings. Binding: APGAR Score Timing (required): ApgarTiming
Observation.subject	This element must be supported. This element is included in summaries.	1..1	Reference(Patient - Child Vital Records)	Who and/or what the observation is about
Observation.effective[x]	This element must be supported. This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: us-core-1
Observation.effective[x].effectiveDateTime			dateTime This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Practitioner Profile This type must be supported. \| US Core Organization Profile \| US Core Patient Profile \| PractitionerRole \| US Core CareTeam Profile \| US Core RelatedPerson Profile)	Who is responsible for the observation
Observation.value[x]	This element must be supported. This element is included in summaries. C	1..1	integer	Actual result
Observation.dataAbsentReason	This element must be supported. C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.hasMember	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Observation Survey Profile This type must be supported. \| US Core QuestionnaireResponse Profile \| MolecularSequence)	Reference to panel or multi-select responses
Observation.derivedFrom	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Observation Survey Profile This type must be supported. \| US Core QuestionnaireResponse Profile This type must be supported. \| US Core DocumentReference Profile \| ImagingStudy \| Media \| MolecularSequence)	Related Observations or QuestionnaireResponses that the observation is made from
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	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:survey	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.code	Base	required	APGAR Score Timing	📦2.0.0	This IG
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📦4.0.1	FHIR Std.

Constraints

Grade

Path(s)

Description

Expression

This structure is derived from USCoreObservationSurveyProfile

Name	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Observation	0..*	USCoreObservationSurveyProfile	Survey Observation
Observation.code	1..1	CodeableConcept	Standard timings for APGAR assessments. Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings. Binding: APGAR Score Timing (required): ApgarTiming
Observation.subject	1..1	Reference(Patient - Child Vital Records)	Who and/or what the observation is about
Observation.value[x]	1..1	integer	Actual result
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.code	Base	required	APGAR Score Timing	📦2.0.0	This IG

Description & Constraints Filter:

Observation C 0..* USCoreObservationSurveyProfile Survey Observation
Constraints: obs-6, obs-7, us-core-2, us-core-3

Observation.id This element is included in summaries. 0..1 id Logical id of this artifact

Observation.meta This element is included in summaries. 0..1 Meta Metadata about the resource

Observation.implicitRules This element is a modifier element. This element is included in summaries. 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 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 This element is included in summaries. 0..* Identifier Business Identifier for observation

Observation.status This element is a modifier element. This element must be supported. 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 This element must be supported. 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred): 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

category:survey

1..1

CodeableConcept

Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
      "code" : "survey"
    }
  ]
}

Observation.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Standard timings for APGAR assessments. Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings.
Binding: APGAR Score Timing (required): ApgarTiming

Observation.subject This element must be supported. This element is included in summaries. 1..1 Reference(Patient - Child Vital Records) Who and/or what the observation is about

Observation.focus 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 This element is included in summaries. 0..1 Reference(Encounter) Healthcare event during which this observation is made

Observation.effective[x] This element must be supported. This element is included in summaries. C 0..1 Clinically relevant time/time-period for observation
Constraints: us-core-1

Observation.effective[x].effectiveDateTime dateTime This target must be supported.

Observation.effective[x].effectivePeriod Period

Observation.effective[x].effectiveTiming Timing

Observation.effective[x].effectiveInstant instant

Observation.issued This element is included in summaries. 0..1 instant Date/Time this version was made available

Observation.performer This element must be supported. This element is included in summaries. 0..* Reference(US Core Practitioner Profile This type must be supported. | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation

Observation.value[x] This element must be supported. This element is included in summaries. C 1..1 integer Actual result

Observation.dataAbsentReason This element must be supported. 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. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Observation.referenceRange.low C 0..1 SimpleQuantity Low Range, if relevant
Constraints: sqty-1

Observation.referenceRange.high C 0..1 SimpleQuantity 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 This element must be supported. This element is included in summaries. 0..* Reference(US Core Observation Survey Profile This type must be supported. | US Core QuestionnaireResponse Profile | MolecularSequence) Reference to panel or multi-select responses

Observation.derivedFrom This element must be supported. This element is included in summaries. 0..* Reference(US Core Observation Survey Profile This type must be supported. | US Core QuestionnaireResponse Profile This type must be supported. | US Core DocumentReference Profile | ImagingStudy | Media | MolecularSequence) Related Observations or QuestionnaireResponses that the observation is made from

Observation.component 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. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Observation.component.code 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] 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	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:survey	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.code	Base	required	APGAR Score Timing	📦2.0.0	This IG
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

Grade

Path(s)

Description

Expression

This structure is derived from USCoreObservationSurveyProfile

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

Patient - Child Vital Records (http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Patient-child-vr)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Observation	C	0..*	USCoreObservationSurveyProfile	Survey Observation Constraints: obs-6, obs-7, us-core-2, us-core-3
Observation.implicitRules	This element is a modifier element. 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. This element must be supported. 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	This element must be supported.	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): 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:survey	This element must be supported.	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/observation-category", "code" : "survey" } ] }`
Observation.code	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Standard timings for APGAR assessments. Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings. Binding: APGAR Score Timing (required): ApgarTiming
Observation.subject	This element must be supported. This element is included in summaries.	1..1	Reference(Patient - Child Vital Records)	Who and/or what the observation is about
Observation.effective[x]	This element must be supported. This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: us-core-1
Observation.effective[x].effectiveDateTime			dateTime This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.effective[x].effectiveInstant			instant
Observation.performer	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Practitioner Profile This type must be supported. \| US Core Organization Profile \| US Core Patient Profile \| PractitionerRole \| US Core CareTeam Profile \| US Core RelatedPerson Profile)	Who is responsible for the observation
Observation.value[x]	This element must be supported. This element is included in summaries. C	1..1	integer	Actual result
Observation.dataAbsentReason	This element must be supported. C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.hasMember	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Observation Survey Profile This type must be supported. \| US Core QuestionnaireResponse Profile \| MolecularSequence)	Reference to panel or multi-select responses
Observation.derivedFrom	This element must be supported. This element is included in summaries.	0..*	Reference(US Core Observation Survey Profile This type must be supported. \| US Core QuestionnaireResponse Profile This type must be supported. \| US Core DocumentReference Profile \| ImagingStudy \| Media \| MolecularSequence)	Related Observations or QuestionnaireResponses that the observation is made from
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	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.category:survey	Base	preferred	Observation Category Codes	📦4.0.1	FHIR Std.
Observation.code	Base	required	APGAR Score Timing	📦2.0.0	This IG
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📦4.0.1	FHIR Std.

Constraints

Grade

Path(s)

Description

Expression

Differential View

This structure is derived from USCoreObservationSurveyProfile

Name	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Observation	0..*	USCoreObservationSurveyProfile	Survey Observation
Observation.code	1..1	CodeableConcept	Standard timings for APGAR assessments. Birth certificates only require 5 and 10 minute timings. Other use cases may require/accept other timings. Binding: APGAR Score Timing (required): ApgarTiming
Observation.subject	1..1	Reference(Patient - Child Vital Records)	Who and/or what the observation is about
Observation.value[x]	1..1	integer	Actual result
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Observation.code	Base	required	APGAR Score Timing	📦2.0.0	This IG

Snapshot ViewView

Description & Constraints Filter:

Observation C 0..* USCoreObservationSurveyProfile Survey Observation
Constraints: obs-6, obs-7, us-core-2, us-core-3

Observation.id This element is included in summaries. 0..1 id Logical id of this artifact

Observation.meta This element is included in summaries. 0..1 Meta Metadata about the resource

Observation.implicitRules This element is a modifier element. This element is included in summaries. 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 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 This element is included in summaries. 0..* Identifier Business Identifier for observation

category:survey

1..1

CodeableConcept

Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
      "code" : "survey"
    }
  ]
}