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Observation-example-clinical-gender.xml

Orders and Observations Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

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Example of a clinical gender observation. For a discussion on representing a patient's gender the Patient Resource. (id = "clinical-gender")

<?xml version="1.0" encoding="UTF-8"?>

<Observation xmlns="http://hl7.org/fhir">
  <id value="clinical-gender"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative with Details</b> </p> <p> <b> id</b> : clinical-gender</p> <p> <b> status</b> : final</p> <p> <b> category</b> : Social History <span> (Details : {http://terminology.hl7.org/CodeSystem/observation-category code 'social-history'
           = 'Social History', given as 'Social History'})</span> </p> <p> <b> code</b> : Gender identity <span> (Details : {LOINC code '76691-5' = 'Gender identity', given as 'Gender identity'})</span> </p> <p> <b> subject</b> : <a> Patient/example</a> </p> <p> <b> encounter</b> : <a> Encounter/example</a> </p> <p> <b> effective</b> : Feb 1, 2018</p> <p> <b> performer</b> : <a> Encounter/example</a> </p> <p> <b> value</b> : Feminism in boy <span> (Details : {SNOMED CT code '191788006' = 'Feminism in boy', given as 'Feminism in boy
           (finding)'})</span> </p> </div> </text> <status value="final"/> 
  <category> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/observation-category"/> 
      <code value="social-history"/> 
      <display value="Social History"/> 
    </coding> 
  </category> 
  <code> 
    <coding> 
      <system value="http://loinc.org"/> 
      <!--    0..1 Identity of the terminology system    -->
      <code value="76691-5"/> 
      <!--    0..1 Symbol in syntax defined by the system    -->
      <display value="Gender identity"/> 
      <!--    0..1 Representation defined by the system    -->
    </coding> 
    <text value="Gender identity"/> 
    <!--    0..1 Plain text representation of the concept    -->
  </code> 
  <subject> 
    <reference value="Patient/example"/> 
  </subject> 
  <encounter> 
    <reference value="Encounter/example"/> 
  </encounter> 
  <effectiveDateTime value="2018-02-01"/> 
  <performer> 
    <!--    0..* Reference(Practitioner|PractitionerRole|Organization|     CareTeam|Patient|RelatedPerson)Who
     is responsible for the observation    -->
    <reference value="Encounter/example"/> 
  </performer> 
  <valueCodeableConcept> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <!--    0..1 Identity of the terminology system    -->
      <code value="191788006"/> 
      <!--    0..1 Symbol in syntax defined by the system    -->
      <display value="Feminism in boy (finding)"/> 
      <!--    0..1 Representation defined by the system    -->
    </coding> 
    <text value="Feminism in boy"/> 
    <!--    0..1 Plain text representation of the concept    -->
  </valueCodeableConcept> 
</Observation> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.