Generated Narrative: StructureDefinition Observation-averageBloodPressure-twcore Name Flags Card. Type Description & Constraints Observation 0..* Observation 測量與簡單陳述 #xD; implicitRules 0..1 uri 建立本內容所依據的一組規則 #xD; modifierExtension 0..* Extension 不可被忽略的擴充資訊 #xD; basedOn 0..* Reference(TW Core CarePlan | DeviceRequest | ImmunizationRecommendation | TW Core MedicationRequest | NutritionOrder | TW Core ServiceRequest) 實現計畫、提案或指示 #xD; partOf 0..* Reference(MedicationAdministration | TW Core MedicationDispense | TW Core MedicationStatement | TW Core Procedure | TW Core Immunization | TW Core ImagingStudy) 所屬的參照事件 #xD; status S 1..1 code registered | preliminary | final | amended + #xD; Slices for category S 1..* CodeableConceptTW 觀察類型的分類 Slice: Unordered, Open by value:coding.code, value:coding.system #xD; category:VSCat S 0..1 CodeableConcept Classification of type of observation #xD; coding 1..* Coding 由術語系統所定義的代碼 #xD; system 1..1 uri 術語系統的識別碼 Required Pattern: http://terminology.hl7.org/CodeSystem/observation-category #xD; code 1..1 code 由系統定義的語法符號 Required Pattern: vital-signs #xD; code S 1..1 CodeableConceptTW 血壓 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 96607-7 #xD; subject S 0..1 Reference(TW Core Patient) 此觀察所關於的對象 #xD; encounter 0..1 Reference(TW Core Encounter) 進行此觀察時的醫療事件 #xD; effective[x] S 1..1 觀察在臨床上相關的時間/時間區間 #xD; effectivePeriod Period S #xD; effectiveDateTime dateTime #xD; <span title="Base StructureDefinition for Timing Type: Specifies an event that may occur multiple times. Timing schedules are used to record when things are planned, expected or requested to occur. The most common usage is in dosage instructions for medications. They are also used when planning care of various kinds, and may be used for reporting the schedule to which past regular activities were carried out.">effectiveTiming Timing #xD; effectiveInstant instant #xD; performer 0..* Reference(TW Core Practitioner | TW Core Organization | TW Core Patient | TW Core PractitionerRole | TW Core CareTeam) 對觀察結果負責的人 #xD; value[x] 0..0 實際結果 #xD; specimen 0..1 Reference(TW Core Specimen) 用於此觀察的標本 #xD; hasMember 0..* Reference(TW Core Observation Vital Signs | TW Core QuestionnaireResponse | MolecularSequence) 屬於觀察群組的相關資源 #xD; derivedFrom 0..* Reference(TW Core DocumentReference | TW Core ImagingStudy | TW Core Media | TW Core QuestionnaireResponse | TW Core Observation Vital Signs | MolecularSequence) 此觀察值衍生自的相關測量 #xD; Slices for component S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; font-style: italic; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; font-style: italic" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( tw-core-2 )">C 2..* BackboneElement 平均收縮壓、平均舒張壓及其他相關指標 Slice: Unordered, Open by pattern:code Constraints: tw-core-2 #xD; component:All Slices Content/Rules for all slices #xD; modifierExtension 0..* Extension 不可被忽略的擴充資訊 #xD; code 1..1 CodeableConceptTW 組件觀察的類型（代碼/類型） #xD; value[x] S 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period 生命徵象組成項目數值 #xD; dataAbsentReason SC 0..1 CodeableConcept 為什麼組成項目的結果會缺少 #xD; component:Systolic S 1..1 BackboneElement 平均收縮壓 #xD; modifierExtension 0..* Extension 不可被忽略的擴充資訊 #xD; code S 1..1 CodeableConceptTW 平均收縮壓代碼 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 96608-5 #xD; value[x] C 0..1 Quantity 平均收縮壓數值 #xD; value S 1..1 decimal 數值（具隱含精確度） #xD; <a href="StructureDefinition-Observation-averageBloodPressure-twcore-definitions.html#Observation.component:Systolic.value[x].comparator" title="說明如何理解與呈現此數值——即實際數值是否因測量問題而大於或小於所述數值。例如，若 comparator 為「<」，則實際數值小於所述數值。">comparator 0..1 code < | <= | >= | > - 如何理解數值 #xD; unit S 1..1 string 單位表示 #xD; system S 1..1 uri 定義單位編碼形式的系統 Required Pattern: http://unitsofmeasure.org #xD; code S 1..1 code 單位的編碼形式 Required Pattern: mm[Hg] #xD; component:Diastolic S 1..1 BackboneElement 平均舒張壓 #xD; modifierExtension 0..* Extension 不可被忽略的擴充資訊 #xD; code S 1..1 CodeableConceptTW 平均舒張壓代碼 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 96609-3 #xD; value[x] C 0..1 Quantity 平均舒張壓數值 #xD; value S 1..1 decimal 數值（具隱含精確度） #xD; <a href="StructureDefinition-Observation-averageBloodPressure-twcore-definitions.html#Observation.component:Diastolic.value[x].comparator" title="說明如何理解與呈現此數值——即實際數值是否因測量問題而大於或小於所述數值。例如，若 comparator 為「<」，則實際數值小於所述數值。">comparator 0..1 code < | <= | >= | > - 如何理解數值 #xD; unit S 1..1 string 單位表示 #xD; system S 1..1 uri 定義單位編碼形式的系統 Required Pattern: http://unitsofmeasure.org #xD; code S 1..1 code 單位的編碼形式 Required Pattern: mm[Hg] #xD; component:Number S 0..1 BackboneElement 測量次數 #xD; modifierExtension 0..* Extension 不可被忽略的擴充資訊 #xD; code S 1..1 CodeableConceptTW 組件觀察的類型（代碼/類型） Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 246432004 #xD; Slices for value[x] 0..1 Quantity 生命徵象組成項目數值 Slice: Unordered, Open by type:$this #xD; value[x]:valueQuantity S 0..1 Quantity Actual component result #xD; value S 1..1 decimal 數值（具隱含精確度） #xD; <a href="StructureDefinition-Observation-averageBloodPressure-twcore-definitions.html#Observation.component:Number.value[x]:valueQuantity.comparator" title="說明如何理解與呈現此數值——即實際數值是否因測量問題而大於或小於所述數值。例如，若 comparator 為「<」，則實際數值小於所述數值。">comparator 0..1 code < | <= | >= | > - 如何理解數值 #xD; Documentation for this format
TW Core Observation Average Blood Pressure
此臺灣核心-平均血壓（TW Core Observation Average Blood Pressure）Profile 說明本 IG 如何進一步定義 FHIR 的 Observation Resource 以呈現平均血壓資料。
關於病人、裝置或其他主體的測量與簡單陳述。
用於簡單觀察，例如裝置測量、實驗室原子結果、生命徵象、身高、體重、吸菸狀態、備註等。其他資源則用於提供觀察的上下文，例如實驗室報告等。
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
dataAbsentReason SHALL only be present if Observation.value[x] is not present
dataAbsentReason.empty() or value.empty()
not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))
If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@value]))
Observation[classCode=OBS, moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
指向建構本 resource 時所遵循規則的參照，處理內容時必須理解這些規則。通常是參照定義特殊規則的實作指南（Implementation Guide），以及其他 profiles 等。
宣告這套規則限制了內容只能被有限的交易夥伴所理解，這從本質上限制了資料的長期有用性。然而，現有的健康生態體系高度分裂，尚未準備好以普遍可計算的方式定義、收集和交換資料。只要有可能，實作者和/或規範編寫者應避免使用此欄位。通常在使用時，此 URL 是對 IG 的參照，該 IG 將這些特殊規則與其他 profiles、value sets 等一起定義為其敘述的一部分。
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
可用於表示不屬於資源基本定義、且會改變所屬元素或其子元素意義的額外資訊。通常這類元素用於否定或限定。為了讓擴充的使用安全且可管理，FHIR 對擴充的定義與使用有嚴格治理規範。任何實作者都可以定義擴充，但必須符合一系列要求。處理資源的應用程式必須檢查 modifier extensions。
任何應用、專案或標準都不應因使用擴充而受到歧視，無論其定義或使用的機構或法域為何。擴充的使用讓 FHIR 規範能維持核心簡潔性。
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
A unique identifier assigned to this observation.
Allows observations to be distinguished and referenced.
OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.
一個由本事件全部或部分實現的計畫、提案或指示。例如，MedicationRequest 可能要求在給藥前，病人需先進行實驗室檢查。
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
此 Observation 所屬的較大事件或步驟。例如，作為某個處置（procedure）的一部分的觀察。
若要將 Observation 連結到 Encounter，請使用 encounter 欄位。關於如何參照其他 Observation，請參見下方說明。
registered | preliminary | final | amended +
此元素被標記為修飾性（modifier），因為 status 可能包含標示資源目前無效的代碼。
Need to track the status of individual results. Some results are finalized before the whole report is finalized.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Codes providing the status of an observation.
status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
用於分類所進行觀察的一般類型的代碼。
除了必要的 category 值集外，此元素也允許根據擁有者自訂的分類方案進行多元分類，且可同時使用多個分類。分類的細緻程度由值集中的 category 概念所決定。
Used for filtering what observations are retrieved and displayed.
Codes for high level observation categories.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
A code that classifies the general type of observation being made.
In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
代碼可以在列舉清單（enumerations）或代碼清單（code lists）中非常隨意地定義，直至有非常正式的定義，如 SNOMED CT—更多資訊見 HL7 v3 核心原則（Core Principles）。編碼的排序是未定義的因而 **必須沒有（SHALL NOT）** 被用來推斷意義。一般來說，最多只有一個編碼值（coding values）會被標記為 UserSelected = true。
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
定義代碼符號意義的代碼系統之識別。
URI 可以是 OID（urn:oid:...）或 UUID（urn:uuid:...）。OID 和 UUID 應參考 HL7 OID 註冊表。否則，URI 應來自 HL7 的 FHIR 特殊 URI 定義列表，或參考某些能清楚且無歧義地建立系統的定義。
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
由系統定義的語法符號。此符號可能是一個預定義的代碼，或是由編碼系統定義的語法中的表達式（例如 post-coordination）。
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
描述所觀察到的內容。有時這也被稱為觀察的「名稱」。
所有的 code-value 配對，以及（若有的話）component.code 與 component.value 的配對，都需要被考慮，才能正確理解此觀察的意義。
Knowing what kind of observation is being made is essential to understanding the observation.
Codes identifying names of simple observations.
< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
此觀察所關於且將觀察記錄存入其病歷的病人、病人群組、地點或設備。如果觀察的實際焦點與主體不同（或是主體的樣本、部分或區域），則由 focus 元素或代碼本身指定觀察的實際焦點。
一般預期此元素的基數為 1..1。唯一可能缺少 subject 的情況是當觀察由不知道病人身分的設備所進行時。在此情況下，觀察必須（SHALL）通過某些上下文/通道匹配技術與病人配對，此時觀察應被更新。
Observations have no value if you don't know who or what they're about.
What the observation is about, when it is not about the subject of record
The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](http://hl7.org/fhir/R4/extension-observation-focuscode.html).
此觀察所發生的醫療事件（例如病人與醫療提供者的互動）。
這通常是發生事件時的就診（encounter），但有些事件可能在就診正式結束之前或之後發起，但仍與就診的上下文有關（例如入院前的實驗室檢查）。
For some observations it may be important to know the link between an observation and a particular encounter.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
觀察在臨床上相關的時間/時間區間
觀察值被視為有效的時間或時間區間。對於生物主體（例如人類患者），這通常被稱為「生理相關時間」。這通常是處置的時間或標本採集的時間，但很多情況下時間/日期的來源是未知的，僅知道時間/日期本身。
除非此觀察是歷史記錄，否則至少應該有一個日期。對於記錄不精確或「模糊」的時間（例如「早餐後」測量的血糖），使用 Timing 資料型別，它允許將測量與日常生活事件相關聯。
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
Date/Time this version was made available
The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](http://hl7.org/fhir/R4/resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.
OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'
進行觀察後所確定的資訊，若該資訊具有簡單值。
一個觀察可能有：1）在此處有單一值，2）同時有一個值和一組相關或組成值，或 3）只有一組相關或組成值。如果存在值，此元素的資料類型應由 Observation.code 決定。如果欄位通常是編碼的，或者與 Observation.code 相關聯的類型定義了一個編碼值，則應使用只有文字的 CodeableConcept 而非字串。更多指引請參見下方備註。
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Provides a reason why the expected value in the element Observation.value[x] is missing.
Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
For many results it is necessary to handle exceptional values in measurements.
Codes specifying why the result (`Observation.value[x]`) is missing.
A categorical assessment of an observation value. For example, high, low, normal.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Codes identifying interpretations of observations.
Comments about the observation or the results.
May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Need to be able to provide free text additional information.
NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
Indicates the site on the subject's body where the observation was made (i.e. the target site).
Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](http://hl7.org/fhir/R4/extension-bodysite.html).
Codes describing anatomical locations. May include laterality.
Indicates the mechanism used to perform the observation.
Only used if not implicit in code for Observation.code.
In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
僅在 Observation.code 的代碼中未隱含標本資訊時才應使用。觀察並非對標本本身進行，而是對主體進行，但許多情況是通過標本進行的。請注意，雖然標本常常會被使用，但並非總是被明確追蹤和報告。同時也請注意，觀察資源可能被用在明確追蹤標本的情境中（例如診斷報告）。
The device used to generate the observation data.
Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.
Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Must have at least a low or a high or text
low.exists() or high.exists() or text.exists()
(exists(f:low) or exists(f:high)or exists(f:text))
outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.
Code for the meaning of a reference range.
< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Need to be able to identify the target population for proper interpretation.
Codes identifying the population the reference range applies to.
The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Text based reference range in an observation
Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
此觀察是一個群組觀察（例如一組檢測、一系列檢驗或一組生命徵象測量），包含目標作為群組的成員。
使用此元素時，一個觀察通常會有一個值或一組相關資源，但在某些情況下兩者都可能存在。關於觀察如何在群組中組合的方式討論，請參見下方備註。請注意，系統可能會從 QuestionnaireResponse 中計算結果到最終分數，並將該分數表示為一個觀察。
Relationships established by OBX-4 usage
代表本觀察值衍生來源的目標資源。例如，根據測量計算的陰離子間隙，或基於超音波影像的胎兒測量。
此元素中列出的所有參考選擇都可以代表臨床觀察和其他可能作為衍生值來源的測量。最常見的參考將是另一個觀察（Observation）。關於觀察如何在群組中組合的方式討論，請參見下方備註。
平均收縮壓、平均舒張壓及其他相關指標
某些觀察有多個組件觀察。這些組件觀察表示為共享相同屬性的獨立代碼-數值對。例如血壓測量的收縮壓和舒張壓組件觀察，以及基因觀察的多個組件觀察。
關於觀察如何在群組中組合的方式討論，請參見下方備註。
Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
If there is no value a data absent reason must be present
value.exists() or dataAbsentReason.exists()
可用於表示不屬於資源基本定義、且會改變所屬元素或其子元素意義的額外資訊。通常這類元素用於否定或限定。為了讓擴充的使用安全且可管理，FHIR 對擴充的定義與使用有嚴格治理規範。任何實作者都可以定義擴充，但必須符合一系列要求。處理資源的應用程式必須檢查修飾擴充。
任何應用、專案或標準都不應因使用擴充而受到歧視，無論其定義或使用的機構或法域為何。擴充的使用讓 FHIR 規範能維持核心簡潔性。修飾擴充不得改變資源或領域資源上任何元素的意義（包括不能改變修飾擴充本身的意義）。
描述觀察到的內容。有時這被稱為觀察「代碼」。
所有的代碼-數值配對和組件.代碼-組件.數值配對都需要被考慮，才能正確理解此觀察的意義。
生命徵象的值通常使用 Quantity 資料型別記錄。對於支援觀察（例如 cuff size）等其他資料型別，可以使用其他資料型別，例如 CodeableConcept。
用於觀察具有一組組件觀察時。一個觀察可能同時有一個值（例如 Apgar score）和組件觀察（用於推導 Apgar score 的觀察）。如果存在值，此元素的資料類型應由 Observation.code 決定。如果欄位通常是編碼的，或者與 Observation.code 相關聯的類型定義了一個編碼值，則應使用只有文字的 CodeableConcept 而非字串。更多指引請參見下方備註。
363714003 |Interprets| < 441742003 |Evaluation finding|
提供 Observation.component.value[x] 元素中預期值缺失的原因。
在 FHIR 觀察中，「空值」或例外值可以通過兩種方式表示。一種方式是直接將它們包含在值集中並在值中表示例外情況。例如，血清學檢測的測量值可以是「已檢測到」、「未檢測到」、「結果不確定」或「未完成檢測」。另一種方式是使用 value 元素來記錄實際觀察值，並使用明確的 dataAbsentReason 元素來記錄例外值。例如，當測量未完成時，可以使用 dataAbsentReason 代碼「error」。由於存在這些選項，因此需要用例協議來解釋例外值的一般觀察。
Provides guide for interpretation of component result
Guidance on how to interpret the value by comparison to a normal or recommended range.
Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7.org/fhir/R4/observation.html#notes) below.
可用於表示不屬於資源基本定義、且會改變所屬元素或其子元素意義的額外資訊。通常這類元素用於否定或限定。為了讓擴充的使用安全且可管理，FHIR 對擴充的定義與使用有嚴格治理規範。任何實作者都可以定義擴充，但必須符合一系列要求。處理資源的應用程式必須檢查修飾擴充。修飾擴充不得改變資源或領域資源上任何元素的意義（包括不能改變修飾擴充本身的意義）。
所有的 code-value 配對和 component.code-component.value 配對都需要被考慮，才能正確理解此觀察的意義。
生命徵象的值通常使用 Quantity 資料型別記錄。對於支援觀察（例如 cuff size）等其他資料型別，可以使用其他資料型別，例如 CodeableConcept。進行觀察後所確定的資訊，若該資訊具有簡單值。
測量數值的大小。此數值在呈現時包含隱含的精確度。
數值中隱含的精確度應始終被尊重。貨幣值有其自己的精確度處理規則（請參照 standard accounting text books）。
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
說明如何理解與呈現此數值——即實際數值是否因測量問題而大於或小於所述數值。例如，若 comparator 為「<」，則實際數值小於所述數值。
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
單位在某些單位表示系統中的可供電腦處理的編碼形式。
建議使用 UCUM 系統，但也可使用 SNOMED CT（慣用單位）或 ISO 4217（貨幣）。使用情境可能會要求來自特定系統的代碼。
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
PQ.code, MO.currency, PQ.translation.code
描述觀察到的內容。有時這被稱為觀察『代碼』。
生命徵象的值通常使用 Quantity 資料型別記錄。對於支援觀察（例如袖帶大小）等其他資料型別，可以使用其他資料型別，例如 CodeableConcept。進行觀察後所確定的資訊，若該資訊具有簡單值。
Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/R4/observation.html#notes) below.
The identification of the system that provides the coded form of the unit.
A computer processable form of the unit in some unit representation system.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.