{
  "resourceType": "StructureDefinition",
  "id": "heartrate",
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eto do\u003c/div\u003e"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-summary",
      "valueMarkdown": "#### Complete Summary of the Mandatory Requirements\r\r1.  One code in `Observation.category` which must have\r    -   a fixed `Observation.category.coding.system`\u003d**\u0027http ://loinc.org\u0027**\r    -   a fixed  `Observation.category.coding.code`\u003d **\u00278867-4\u0027**\r    -   The code (or codes) for the measurement obtained  in `Observation.code`. All codes\r        SHALL have a system value\r1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsentReason\r   - Each Observation.valueQuantity must have:\r     - One numeric value in Observation.valueQuantity.value\r     - a fixed Observation.valueQuantity.system\u003d\"http://unitsofmeasure.org\"\r     - a UCUM unit code in Observation.valueQuantity.code \u003d **\u0027/min\u0027**"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 4
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "oo"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "normative"
    },
    {
      "url": "http://hl7.org/fhir/tools/StructureDefinition/profile-summary",
      "valueString": "#### Complete Summary of the Mandatory Requirements\r\r1.  One code in `Observation.category` which must have\r    -   a fixed `Observation.category.coding.system`\u003d**\u0027http ://loinc.org\u0027**\r    -   a fixed  `Observation.category.coding.code`\u003d **\u00278867-4\u0027**\r    -   The code (or codes) for the measurement obtained  in `Observation.code`. All codes\r        SHALL have a system value\r1. Either one Observation.valueQuantity or, if there is no value, one code in Observation.DataAbsentReason\r   - Each Observation.valueQuantity must have:\r     - One numeric value in Observation.valueQuantity.value\r     - a fixed Observation.valueQuantity.system\u003d\"http://unitsofmeasure.org\"\r     - a UCUM unit code in Observation.valueQuantity.code \u003d **\u0027/min\u0027**"
    }
  ],
  "url": "http://hl7.org/fhir/StructureDefinition/heartrate",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.5.1454"
    }
  ],
  "version": "6.0.0-ballot4",
  "name": "Observationheartrate",
  "title": "Observation Heart Rate Profile",
  "status": "draft",
  "experimental": false,
  "date": "2018-08-11",
  "publisher": "HL7 International / Orders and Observations",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations"
        }
      ]
    }
  ],
  "description": "FHIR Heart Rate Profile",
  "fhirVersion": "6.0.0-ballot4",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "sct-concept",
      "uri": "http://snomed.info/conceptdomain",
      "name": "SNOMED CT Concept Domain Binding"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 V2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    },
    {
      "identity": "sct-attr",
      "uri": "http://snomed.org/attributebinding",
      "name": "SNOMED CT Attribute Binding"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/vitalsigns",
  "derivation": "constraint",
  "snapshot": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version",
        "valueString": "6.0.0-ballot4"
      }
    ],
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "FHIR Heart Rate Profile",
        "definition": "This profile defines how to represent heart rate observations in FHIR using a standard LOINC code and UCUM units of measure.",
        "comment": "Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc.  Other resources are used to provide context for observations such as laboratory reports, etc.",
        "alias": [
          "Vital Sign",
          "Measurement",
          "Result",
          "Test Performed",
          "Observable",
          "Vital Signs",
          "Results",
          "Tests"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation",
          "min": 0,
          "max": "*"
        },
        "constraint": [
          {
            "key": "dom-2",
            "severity": "error",
            "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
            "expression": "contained.contained.empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-3",
            "severity": "error",
            "human": "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",
            "expression": "contained.where(((\u0027#\u0027+id.trace(\u0027id\u0027) in %resource.descendants().select(reference | as(uri))) or descendants().where(reference\u003d\u0027#\u0027 | as(uri)\u003d\u0027#\u0027).exists()).not()).trace(\u0027unmatched\u0027, id).empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-4",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
            "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-5",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a security label",
            "expression": "contained.meta.security.empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
                "valueBoolean": true
              },
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
                "valueMarkdown": "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."
              }
            ],
            "key": "dom-6",
            "severity": "warning",
            "human": "A resource should have narrative for robust management",
            "expression": "text.`div`.exists()",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "obs-6",
            "severity": "error",
            "human": "Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not present",
            "expression": "dataAbsentReason.empty() or value.empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "obs-7",
            "severity": "error",
            "human": "If Observation.component.code is the same as Observation.code, then Observation.value SHALL NOT be present (the Observation.component.value[x] holds the value).",
            "expression": "value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "obs-10",
            "severity": "error",
            "human": "Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x] is not present",
            "expression": "component.empty() or component.where(dataAbsentReason.exists()).all(value.empty())",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "obs-11",
            "severity": "error",
            "human": "if organizer exists and organizer \u003d true, then value[x], dataAbsentReason and component SHALL NOT be present",
            "expression": "(organizer.exists() and organizer.allTrue()) implies (value.empty() and dataAbsentReason.empty() and component.empty())",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "obs-12",
            "severity": "warning",
            "human": "All observations SHOULD have a performer",
            "expression": "performer.exists()",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "vsp-1",
            "severity": "error",
            "human": "if Observation.effective[x] (as dateTime) has a value then that value shall be precise at least to the day",
            "expression": "(effective as dateTime).toString().length() \u003e\u003d 8",
            "source": "http://hl7.org/fhir/StructureDefinition/vitalsigns"
          },
          {
            "key": "vsp-2",
            "severity": "error",
            "human": "If there is no component or hasMember element then either a value[x] or a data absent reason must be present.",
            "expression": "(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())",
            "source": "http://hl7.org/fhir/StructureDefinition/vitalsigns"
          },
          {
            "key": "vs-4",
            "severity": "error",
            "human": "For single vital signs observations (that do not require use of components or hasMember), then either a value[x] or a data absent reason must be present.",
            "expression": "dataAbsentReason.exists() or value.exists()"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "Entity, Role, or Act,Observation[classCode\u003dOBS, moodCode\u003dEVN]"
          },
          {
            "identity": "workflow",
            "map": "Event"
          },
          {
            "identity": "w5",
            "map": "clinical.diagnostics"
          },
          {
            "identity": "v2",
            "map": "OBX"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 363787002 |Observable entity|"
          }
        ]
      },
      {
        "id": "Observation.id",
        "path": "Observation.id",
        "short": "Logical id of this artifact",
        "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
        "comment": "Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "id"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Observation.meta",
        "path": "Observation.meta",
        "short": "Metadata about the resource",
        "definition": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.meta",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Meta"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Observation.implicitRules",
        "path": "Observation.implicitRules",
        "short": "A set of rules under which this content was created",
        "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the [additionalImplicitRules](https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-additionalImplicitRules.html) extension.",
        "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.implicitRules",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": true,
        "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation",
        "isSummary": true
      },
      {
        "id": "Observation.language",
        "path": "Observation.language",
        "short": "Language of the resource content",
        "definition": "The base language in which the resource is written.",
        "comment": "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).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.language",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "Language"
            }
          ],
          "strength": "required",
          "description": "IETF language tag for a human language",
          "valueSet": "http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot4",
          "additional": [
            {
              "purpose": "starter",
              "valueSet": "http://hl7.org/fhir/ValueSet/languages"
            }
          ]
        }
      },
      {
        "id": "Observation.text",
        "path": "Observation.text",
        "short": "Text summary of the resource, for human interpretation",
        "definition": "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.",
        "comment": "Contained resources do not have a 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\u003d1 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.",
        "alias": [
          "narrative",
          "html",
          "xhtml",
          "display"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "DomainResource.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Narrative"
          }
        ],
        "condition": [
          "dom-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "Act.text?"
          }
        ]
      },
      {
        "id": "Observation.contained",
        "path": "Observation.contained",
        "short": "Contained, inline Resources",
        "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.",
        "comment": "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. Contained resources may be a resource type defined in the FHIR specification, or an [additional resource](resource.html#additional).",
        "alias": [
          "inline resources",
          "anonymous resources",
          "contained resources"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.contained",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Resource"
          }
        ],
        "condition": [
          "dom-2",
          "dom-4",
          "dom-3",
          "dom-5"
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.extension",
        "path": "Observation.extension",
        "short": "Additional content defined by implementations",
        "definition": "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 managable, 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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.modifierExtension",
        "path": "Observation.modifierExtension",
        "short": "Extensions that cannot be ignored",
        "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.identifier",
        "path": "Observation.identifier",
        "short": "Business Identifier for observation",
        "definition": "A unique identifier assigned to this observation.",
        "requirements": "Allows observations to be distinguished and referenced.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.identifier",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "v2",
            "map": "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 3) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4."
          },
          {
            "identity": "rim",
            "map": "id"
          }
        ]
      },
      {
        "id": "Observation.basedOn",
        "path": "Observation.basedOn",
        "short": "Fulfills plan, proposal or order",
        "definition": "A plan, proposal or order that is fulfilled in whole or in part by this event.  For example, a MedicationRequest may require a patient to have laboratory test performed before  it is dispensed.",
        "requirements": "Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.",
        "alias": [
          "Fulfills"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.basedOn",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/CarePlan",
              "http://hl7.org/fhir/StructureDefinition/DeviceRequest",
              "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
              "http://hl7.org/fhir/StructureDefinition/NutritionOrder",
              "http://hl7.org/fhir/StructureDefinition/ServiceRequest"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.basedOn"
          },
          {
            "identity": "v2",
            "map": "ORC"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode\u003dCOMP].source[moodCode\u003dEVN]"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy",
        "path": "Observation.triggeredBy",
        "short": "Triggering observation(s)",
        "definition": "Identifies the observation(s) that triggered the performance of this observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.triggeredBy",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children or both",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "ORC"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode\u003dCOMP].source[moodCode\u003dEVN]"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.id",
        "path": "Observation.triggeredBy.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.extension",
        "path": "Observation.triggeredBy.extension",
        "short": "Additional content defined by implementations",
        "definition": "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 managable, 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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.modifierExtension",
        "path": "Observation.triggeredBy.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.observation",
        "path": "Observation.triggeredBy.observation",
        "short": "Triggering observation",
        "definition": "Reference to the triggering observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.triggeredBy.observation",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Observation"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "outBoundRelationship"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.type",
        "path": "Observation.triggeredBy.type",
        "short": "reflex | repeat | re-run",
        "definition": "The type of trigger.\nReflex | Repeat | Re-run.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.triggeredBy.type",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "TriggeredByType"
            }
          ],
          "strength": "required",
          "description": "The type of TriggeredBy Observation.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-triggeredbytype|6.0.0-ballot4"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.triggeredBy.reason",
        "path": "Observation.triggeredBy.reason",
        "short": "Reason that the observation was triggered",
        "definition": "Provides the reason why this observation was performed as a result of the observation(s) referenced.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.triggeredBy.reason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "annotation"
          }
        ]
      },
      {
        "id": "Observation.partOf",
        "path": "Observation.partOf",
        "short": "Part of referenced event",
        "definition": "A larger event of which this particular Observation is a component or step.  For example,  an observation as part of a procedure.",
        "comment": "To link an Observation to an Encounter use `encounter`.  See the  [Notes](observation.html#obsgrouping) below for guidance on referencing another Observation.",
        "alias": [
          "Container"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.partOf",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/MedicationAdministration",
              "http://hl7.org/fhir/StructureDefinition/MedicationDispense",
              "http://hl7.org/fhir/StructureDefinition/MedicationStatement",
              "http://hl7.org/fhir/StructureDefinition/Procedure",
              "http://hl7.org/fhir/StructureDefinition/Immunization",
              "http://hl7.org/fhir/StructureDefinition/ImagingStudy"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.partOf"
          },
          {
            "identity": "v2",
            "map": "Varies by domain"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode\u003dFLFS].target"
          }
        ]
      },
      {
        "id": "Observation.status",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
            "valueString": "default: final"
          }
        ],
        "path": "Observation.status",
        "short": "registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained",
        "definition": "The status of the result value.",
        "comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
        "requirements": "Need to track the status of individual results. Some results are finalized before the whole report is finalized.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.status",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": true,
        "isModifierReason": "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",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationStatus"
            }
          ],
          "strength": "required",
          "description": "Codes providing the status of an observation.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-status|6.0.0-ballot4"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "FiveWs.status"
          },
          {
            "identity": "v2",
            "map": "OBX-11 Map FHIR Observation.status to OBX-11. If FHIR carries Observation.dataAbsentReason \u003d ‘not-asked’, set OBX-11 to the v2 as  ‘N’. If there is alternate-code extension on Observation.status with code ‘X’, set OBX-11 as ‘X’."
          },
          {
            "identity": "rim",
            "map": "status  Amended \u0026 Final are differentiated by whether it is the subject of a ControlAct event with a type of \"revise\""
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 445584004 |Report by finality status|"
          }
        ]
      },
      {
        "id": "Observation.category",
        "path": "Observation.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "short": "Classification of  type of observation",
        "definition": "A code that classifies the general type of observation being made.",
        "comment": "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.",
        "requirements": "Used for filtering what observations are retrieved and displayed.",
        "min": 1,
        "max": "*",
        "base": {
          "path": "Observation.category",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCategory"
            }
          ],
          "strength": "preferred",
          "description": "Codes for high level observation categories.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-category"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.category"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "OBX-29"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode\u003d\"COMP].target[classCode\u003d\"LIST\", moodCode\u003d\"EVN\"].code"
          }
        ]
      },
      {
        "id": "Observation.category:VSCat",
        "path": "Observation.category",
        "sliceName": "VSCat",
        "short": "Classification of  type of observation",
        "definition": "A code that classifies the general type of observation being made as a vital sign related observation, whether a point-in-time or calculated vital sign observation. ",
        "comment": "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.",
        "requirements": "Used for filtering what observations are retrieved and displayed.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.category",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/observation-category",
              "code": "vital-signs"
            }
          ]
        },
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCategory"
            }
          ],
          "strength": "preferred",
          "description": "Codes for high level observation categories.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-category"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.category"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "OBX-29"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode\u003d\"COMP].target[classCode\u003d\"LIST\", moodCode\u003d\"EVN\"].code"
          }
        ]
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "short": "Heart Rate",
        "definition": "Heart Rate",
        "comment": "*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation. All codings in Observation.code are expected to be sufficiently precise to allow a user with the code and value to be able to understand the value - though not all codes will necessarily convey the same level of detail. Codings in Observation.category SHOULD be concepts that are too broad to be able to understand the meaning of the Observation.value without also having an Observation.code.\n\nSee [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop) for additional information.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "alias": [
          "Name"
        ],
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "8867-4"
            }
          ]
        },
        "condition": [
          "obs-7"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VitalSignsHeartRate"
            }
          ],
          "strength": "preferred",
          "description": "This identifies the set of LOINC codes that are appropriate for representing heart rate vital sign measurements in Observation.code.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-vitalsign-heartrate"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 363787002 |Observable entity| OR \u003c 386053000 |Evaluation procedure|"
          }
        ]
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "short": "Who and/or what the observation is about",
        "definition": "The patient, or group of patients, location, device, organization, procedure or practitioner this observation is about and into whose or what record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.",
        "comment": "One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. The subject of an Observation may in some cases be a procedure.  This supports the regulatory inspection use case where observations are captured during inspections of a procedure that is being performed (independent of any particular patient or whether patient related at all).",
        "requirements": "Observations have no value if you don\u0027t know who or what they\u0027re about.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.subject",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.subject"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          },
          {
            "identity": "v2",
            "map": "PID-3"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dRTGT]"
          }
        ]
      },
      {
        "id": "Observation.focus",
        "path": "Observation.focus",
        "short": "What the observation is about, when it is not about the subject of record",
        "definition": "The actual focus of an observation when it is not the subject 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\u0027s record.  The focus of an observation could also be an existing condition,  an intervention, the subject\u0027s 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\u0027s tracheostomy tube. In this example, the child is the patient of record and the mother is the focus. As another use case,\r\ra caregiver (RelatedPerson) has back strain and is unable to provide ADL support to a patient (Subject).",
        "comment": "Examples demonstrating the use of subject and focus in an Observation:\r\r- A parent is trained to change their child\u0027s tracheostomy tube. The child is the subject, and the parent is the focus.\r\r- A fetal heart rate recorded in a mother\u0027s record. The mother is the subject, and the fetus is the focus.\r\r- Features of a body structure, such as a tumor. The patient is the subject, and the specific body structure is the focus.\r\r- Metrics captured from a medical device. The patient-attached device is the subject, the specific device metric is the focus, and the observing device itself is referenced in .device.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.focus",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": true,
        "isModifierReason": "This element is labeled as a modifier because it changes who is the target of the observation. See the use cases in the definition.",
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dSBJ]"
          }
        ]
      },
      {
        "id": "Observation.organizer",
        "path": "Observation.organizer",
        "short": "This observation organizes/groups a set of sub-observations",
        "definition": "This observation serves as an organizer or grouper for a set of (one or more) sub-observations.",
        "comment": "An observation that is an organizer/grouper does not have a value (or dataAbsentReason) of its own - all values are included in the sub-observations.  The sub-observations are linked using hasMember element references (in some instances there may be no hasMember references, as it is possible that the organizer/grouper observation may be created first, and the sub-observations are not created until a later time).  An organizer/grouper observation also does not contain any components.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.organizer",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "boolean"
          }
        ],
        "condition": [
          "obs-11"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Observation.encounter",
        "path": "Observation.encounter",
        "short": "Healthcare event during which this observation is made. If you need to place the observation within one or more episodes of care, use the workflow-episodeOfCare extension",
        "definition": "The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made.",
        "comment": "This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).",
        "requirements": "For some observations it may be important to know the link between an observation and a particular encounter.",
        "alias": [
          "Context"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.encounter",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Encounter"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.encounter"
          },
          {
            "identity": "w5",
            "map": "FiveWs.context"
          },
          {
            "identity": "v2",
            "map": "PV1"
          },
          {
            "identity": "rim",
            "map": "inboundRelationship[typeCode\u003dCOMP].source[classCode\u003dENC, moodCode\u003dEVN]"
          }
        ]
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "short": "Vital Signs are point in time measurements and are recorded using the dateTime data type",
        "definition": "Vital Signs are point in time measurements and are recorded using the dateTime data type.",
        "comment": "At least a date should be present unless this observation is a historical report.  For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.",
        "requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.",
        "alias": [
          "Occurrence"
        ],
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.effective[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "condition": [
          "vsp-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.occurrence[x]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.done[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-14 (If Observation carries the AnalysisDateTime extension, then map the extension to OBX-19)"
          },
          {
            "identity": "rim",
            "map": "effectiveTime"
          }
        ]
      },
      {
        "id": "Observation.issued",
        "path": "Observation.issued",
        "short": "Date/Time this version was made available",
        "definition": "The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.",
        "comment": "For Observations that don\u0027t require review and verification, it may be the same as the [`lastUpdated` ](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\u0027t require the new version to be reviewed and verified again.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.issued",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "instant"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.recorded"
          },
          {
            "identity": "v2",
            "map": "OBR-22 (or MSH-7), or perhaps OBX-19 (depends on who observation made)"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dAUT].time"
          }
        ]
      },
      {
        "id": "Observation.performer",
        "path": "Observation.performer",
        "short": "Who is responsible for the observation",
        "definition": "Who was responsible for asserting the observed value as \"true\".",
        "comment": "Group is only allowed in the circumstance where the group represents a family or a household, and should not represent groups of Practitioners where other more specific resources can be used instead.",
        "requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.performer",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Practitioner",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
              "http://hl7.org/fhir/StructureDefinition/Organization",
              "http://hl7.org/fhir/StructureDefinition/CareTeam",
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson",
              "http://hl7.org/fhir/StructureDefinition/HealthcareService",
              "http://hl7.org/fhir/StructureDefinition/Group"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.performer.actor"
          },
          {
            "identity": "w5",
            "map": "FiveWs.actor"
          },
          {
            "identity": "v2",
            "map": "OBX-15, OBX-16, OBX-23, OBX-24, OBX-25. Person/role → OBX-16 (Responsible Observer). If conveying performing org and medical director: use OBX-25 (XCN) for the director with role code “MDIR” (system v2-0912), and OBX-23/24 for org name/address; if there is no director, OBX-23/24 carry the org. OBX-15 is available for producer id (identifier for the producer)."
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dPRF]"
          }
        ]
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "closed"
        },
        "short": "The quantity for the vital sign being observed.",
        "definition": "The quantity for the vital sign being observed.",
        "comment": "- An observation may have:\n  1.  a single value here\n  1.  both a value and a set of related or component values\n  1.  only a set of related or component values.\n-  If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- For additional guidance, see the [Notes section](observation.html#notes) below. \n- See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop) for additional information.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "condition": [
          "obs-7",
          "obs-6",
          "obs-11",
          "vsp-2"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VitalSignsUnits"
            }
          ],
          "strength": "preferred",
          "description": "Commonly encountered UCUM units for recording Vital Signs.",
          "valueSet": "http://hl7.org/fhir/ValueSet/ucum-vitals-common"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-2, OBX-5, OBX-6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 441742003 |Evaluation finding|"
          }
        ]
      },
      {
        "id": "Observation.value[x]:valueQuantity",
        "path": "Observation.value[x]",
        "sliceName": "valueQuantity",
        "short": "The quantity for the vital sign being observed.",
        "definition": "The quantity for the vital sign being observed.",
        "comment": "- An observation may have:\n  1.  a single value here\n  1.  both a value and a set of related or component values\n  1.  only a set of related or component values.\n-  If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- For additional guidance, see the [Notes section](observation.html#notes) below. \n- See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop) for additional information.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "condition": [
          "obs-7",
          "obs-6",
          "obs-11",
          "vsp-2",
          "vsp-4"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition",
              "valueString": "Common UCUM rate units for vital signs including heart and respiratory rate."
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VitalSignsRateUnits"
            }
          ],
          "strength": "required",
          "description": "/min",
          "valueSet": "http://hl7.org/fhir/ValueSet/ucum-vitalsignsrate"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-2, OBX-5, OBX-6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 441742003 |Evaluation finding|"
          }
        ]
      },
      {
        "id": "Observation.dataAbsentReason",
        "path": "Observation.dataAbsentReason",
        "short": "Why the result value is missing",
        "definition": "Provides a reason why the expected value in the element Observation.value[x] is missing.",
        "comment": "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\".   \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "obs-6",
          "obs-11",
          "vsp-2",
          "vsp-4"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-32, OBX-11. Map Observation.dataAbsentReason to OBX-32 (Observation Value Absent Reason). Additionally, when dataAbsentReason.code \u003d \u0027not-asked\u0027, also set OBX-11 \u003d \u0027N\u0027."
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.interpretation",
        "path": "Observation.interpretation",
        "short": "High, low, normal, etc",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "Historically used for laboratory results (known as \u0027abnormal flag\u0027 ),  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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 260245000 |Findings values|"
          }
        ]
      },
      {
        "id": "Observation.interpretationContext",
        "path": "Observation.interpretationContext",
        "short": "Context for understanding the observation",
        "definition": "Other preceding or concurrent information that is critical to understand the context and significance of the observation.",
        "comment": "This element provides essential contextual information that affects how the observation should be interpreted. For example, knowing that a patient is diabetic, fasting, or paraplegic may be critical to properly understanding lab results or other observations.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.interpretationContext",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableReference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretationContext"
            }
          ],
          "strength": "example",
          "description": "Codes identifying contextual factors that affect interpretation of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation-context"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode\u003dPERT].target"
          }
        ]
      },
      {
        "id": "Observation.note",
        "path": "Observation.note",
        "short": "Comments about the observation",
        "definition": "Comments about the observation or the results.",
        "comment": "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.",
        "requirements": "Need to be able to provide free text additional information.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.note",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Annotation"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.note"
          },
          {
            "identity": "v2",
            "map": "NTE-3 (partner NTE to OBX, or sometimes another (child?) OBX)"
          },
          {
            "identity": "rim",
            "map": "subjectOf.observationEvent[code\u003d\"annotation\"].value"
          }
        ]
      },
      {
        "id": "Observation.bodySite",
        "path": "Observation.bodySite",
        "short": "DEPRECATED: Observed body part",
        "definition": "DEPRECATED: This element is deprecated. Use bodyStructure instead. Indicates the site on the subject\u0027s body where the observation was made (i.e. the target site).",
        "comment": "DEPRECATED: Use bodyStructure instead. 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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.bodySite",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-20"
          },
          {
            "identity": "rim",
            "map": "targetSiteCode"
          },
          {
            "identity": "sct-attr",
            "map": "718497002 |Inherent location|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 123037004 |Body structure|"
          }
        ]
      },
      {
        "id": "Observation.bodyStructure",
        "path": "Observation.bodyStructure",
        "short": "Observed body structure",
        "definition": "Indicates the body structure on the subject\u0027s body where the observation was made (i.e. the target site).",
        "comment": "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. Use this element instead of the deprecated bodySite element.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.bodyStructure",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableReference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/BodyStructure"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "BodyStructure"
            }
          ],
          "strength": "example",
          "description": "SNOMED CT Body Structures",
          "valueSet": "http://hl7.org/fhir/ValueSet/body-site"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "targetSiteCode"
          }
        ]
      },
      {
        "id": "Observation.method",
        "path": "Observation.method",
        "short": "How it was done",
        "definition": "Indicates the mechanism used to perform the observation.",
        "comment": "Only used if not implicit in code for Observation.code.",
        "requirements": "In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.method",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMethod"
            }
          ],
          "strength": "example",
          "description": "Methods for simple observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-methods"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-17"
          },
          {
            "identity": "rim",
            "map": "methodCode"
          }
        ]
      },
      {
        "id": "Observation.specimen",
        "path": "Observation.specimen",
        "short": "Specimen used for this observation",
        "definition": "The specimen that was used when this observation was made.",
        "comment": "SHOULD be used when the observation is performed on a specimen. The type of specimen SHOULD be consistent with anything implied in the `Observation.code` value.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.specimen",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Specimen",
              "http://hl7.org/fhir/StructureDefinition/Group"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "obs-9",
            "severity": "error",
            "human": "If Observation.specimen is a reference to Group, the group can only have specimens",
            "expression": "(reference.resolve().exists() and reference.resolve() is Group) implies reference.resolve().member.entity.resolve().all($this is Specimen)",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "SPM segment (OBX-33 for Specimen.identifier mapping)"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dSPC].specimen"
          },
          {
            "identity": "sct-attr",
            "map": "704319004 |Inherent in|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 123038009 |Specimen|"
          }
        ]
      },
      {
        "id": "Observation.device",
        "path": "Observation.device",
        "short": "A reference to the device that generates the measurements or the device settings for the device",
        "definition": "A reference to the device that generates the measurements or the device settings for the device.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.device",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Device",
              "http://hl7.org/fhir/StructureDefinition/DeviceMetric"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-18 / PRT -10"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode\u003dDEV]"
          },
          {
            "identity": "sct-attr",
            "map": "424226004 |Using device|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 49062001 |Device|"
          }
        ]
      },
      {
        "id": "Observation.referenceRange",
        "path": "Observation.referenceRange",
        "short": "Provides guide for interpretation",
        "definition": "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.",
        "comment": "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\u0027s 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.",
        "requirements": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.referenceRange",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children or both",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "obs-3",
            "severity": "error",
            "human": "Must have at least a low or a high or text",
            "expression": "low.exists() or high.exists() or text.exists()",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode\u003dREFV]/target[classCode\u003dOBS, moodCode\u003dEVN]"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.id",
        "path": "Observation.referenceRange.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.extension",
        "path": "Observation.referenceRange.extension",
        "short": "Additional content defined by implementations",
        "definition": "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 managable, 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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.modifierExtension",
        "path": "Observation.referenceRange.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.low",
        "path": "Observation.referenceRange.low",
        "short": "Low Range, if relevant",
        "definition": "The value of the low bound of the reference range.",
        "comment": "When low.comparator is not populated (the low.comparator element was not available prior to        FHIR R6), the low bound of the reference range endpoint is inclusive of the value (e.g., reference range is        \u0027\u003e\u003d5\u0027 - \u0027\u003c\u003d9\u0027).  Alternatively, this can be specified explicitly by populating low.comparator \u003d \u0027\u003e\u003d\u0027.         When the low bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range        is \u0027\u003e5\u0027 - \u0027\u003c9\u0027), this is specified with low.comparator \u003d \u0027\u003e\u0027.  If the low bound is omitted,  it is        assumed to be meaningless (e.g., reference range is \u0027\u003c\u003d2.3\u0027).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.low",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "condition": [
          "obs-3"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "obs-13",
            "severity": "error",
            "human": "If low.comparator exists, it must be \u0027\u003e\u003d\u0027 or \u0027\u003e\u0027.",
            "expression": "comparator.exists() implies (comparator \u003d \u0027\u003e\u003d\u0027 or comparator \u003d \u0027\u003e\u0027)",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:IVL_PQ.low"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.high",
        "path": "Observation.referenceRange.high",
        "short": "High Range, if relevant",
        "definition": "The value of the high bound of the reference range.",
        "comment": "When high.comparator is not populated (the high.comparator element was not available prior to        FHIR R6), the high bound of the reference range endpoint is inclusive of the value (e.g., reference range is        \u0027\u003e\u003d5\u0027 - \u0027\u003c\u003d9\u0027).  Alternatively, this can be specified explicitly by populating high.comparator \u003d \u0027\u003c\u003d\u0027.         When the high bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range        is \u0027\u003e5\u0027 - \u0027\u003c9\u0027), this is specified with high.comparator \u003d \u0027\u003c\u0027.  If the high bound is omitted,  it is        assumed to be meaningless (e.g., reference range is \u0027\u003e\u003d2.3\u0027).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.high",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "condition": [
          "obs-3"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "obs-14",
            "severity": "error",
            "human": "If high.comparator exists, it must be \u0027\u003c\u003d\u0027 or \u0027\u003c\u0027.",
            "expression": "comparator.exists() implies (comparator \u003d \u0027\u003c\u003d\u0027 or comparator \u003d \u0027\u003c\u0027)",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:IVL_PQ.high"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.normalValue",
        "path": "Observation.referenceRange.normalValue",
        "short": "Normal value, if relevant",
        "definition": "The value of the normal value of the reference range.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.normalValue",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationReferenceRangeNormalValue"
            }
          ],
          "strength": "example",
          "description": "Codes identifying the normal value of the observation.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-referencerange-normalvalue"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:IVL_PQ.normal"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.type",
        "path": "Observation.referenceRange.type",
        "short": "Reference range qualifier",
        "definition": "Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.",
        "comment": "This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed.",
        "requirements": "Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc.,  - for proper interpretation.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationRangeMeaning"
            }
          ],
          "strength": "preferred",
          "description": "Code for the meaning of a reference range.",
          "valueSet": "http://hl7.org/fhir/ValueSet/referencerange-meaning"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-10"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 260245000 |Findings values| OR  \r\u003c 365860008 |General clinical state finding| \rOR \r\u003c 250171008 |Clinical history or observation findings| OR  \r\u003c 415229000 |Racial group| OR \r\u003c 365400002 |Finding of puberty stage| OR\r\u003c 443938003 |Procedure carried out on subject|"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.appliesTo",
        "path": "Observation.referenceRange.appliesTo",
        "short": "Reference range population",
        "definition": "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.",
        "comment": "This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed.",
        "requirements": "Need to be able to identify the target population for proper interpretation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.referenceRange.appliesTo",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationRangeType"
            }
          ],
          "strength": "example",
          "description": "Codes identifying the population the reference range applies to.",
          "valueSet": "http://hl7.org/fhir/ValueSet/referencerange-appliesto"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-10"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 260245000 |Findings values| OR  \r\u003c 365860008 |General clinical state finding| \rOR \r\u003c 250171008 |Clinical history or observation findings| OR  \r\u003c 415229000 |Racial group| OR \r\u003c 365400002 |Finding of puberty stage| OR\r\u003c 443938003 |Procedure carried out on subject|"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.age",
        "path": "Observation.referenceRange.age",
        "short": "Applicable age range, if relevant",
        "definition": "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.",
        "requirements": "Some analytes vary greatly over age.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.age",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Range"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode\u003dPRCN].targetObservationCriterion[code\u003d\"age\"].value"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.text",
        "path": "Observation.referenceRange.text",
        "short": "Text based reference range in an observation",
        "definition": "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\".",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "markdown"
          }
        ],
        "condition": [
          "obs-3"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:ST"
          }
        ]
      },
      {
        "id": "Observation.hasMember",
        "path": "Observation.hasMember",
        "short": "Used when reporting observations included in a vital signs panel",
        "definition": "Used when reporting observations included in a vital signs panel.",
        "comment": "When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases.  For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below.  Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.html)  into a final score and represent the score as an Observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.hasMember",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Observation"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Relationships established by OBX-4 usage"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship"
          }
        ]
      },
      {
        "id": "Observation.derivedFrom",
        "path": "Observation.derivedFrom",
        "short": "Related resource from which the observation is made",
        "definition": "The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.",
        "comment": "All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value.  The most common reference will be another Observation.  For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.derivedFrom",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/DocumentReference",
              "http://hl7.org/fhir/StructureDefinition/Observation"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Relationships established by OBX-4 usage"
          },
          {
            "identity": "rim",
            "map": ".targetObservation"
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "short": "Component results",
        "definition": "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.",
        "comment": "For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below.",
        "requirements": "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, reference range, dataAbsentReason, and interpretation can differ between the components and are not inherited; these should be provided if appropriate.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "obs-7",
          "obs-11",
          "obs-10"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children or both",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode\u003dCOMP]"
          }
        ]
      },
      {
        "id": "Observation.component.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component.extension",
        "path": "Observation.component.extension",
        "short": "Additional content defined by implementations",
        "definition": "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 managable, 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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component.modifierExtension",
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component.code",
        "path": "Observation.component.code",
        "short": "Vital Sign measurement or component",
        "definition": "Vital Sign measurement or component.",
        "comment": "*All* code-value and  component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "obs-7"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            }
          ],
          "strength": "example",
          "description": "Codes identifying names of simple observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-codes-observationorboth"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 363787002 |Observable entity| OR \r\u003c 386053000 |Evaluation procedure|"
          }
        ]
      },
      {
        "id": "Observation.component.value[x]",
        "path": "Observation.component.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "short": "The value for the vital sign component being observed.",
        "definition": "The value for the vital sign component being observed.",
        "comment": "Used when observation has a set of component observations:\n-  An observation may have both a value (e.g. an  Apgar score) and component observations (the observations from which the Apgar score was derived). \n-  If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- For additional guidance, see the [Notes section](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          },
          {
            "code": "CodeableConcept"
          },
          {
            "code": "string"
          },
          {
            "code": "boolean"
          },
          {
            "code": "integer"
          },
          {
            "code": "Range"
          },
          {
            "code": "Ratio"
          },
          {
            "code": "SampledData"
          },
          {
            "code": "time"
          },
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          },
          {
            "code": "Attachment"
          }
        ],
        "condition": [
          "obs-10"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-2, OBX-5, OBX-6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| \u003c 441742003 |Evaluation finding|"
          }
        ]
      },
      {
        "id": "Observation.component.value[x]:valueQuantity",
        "path": "Observation.component.value[x]",
        "sliceName": "valueQuantity",
        "short": "Vital Sign component value recorded as a component with UCUM (preferred)",
        "definition": "Vital Sign component value recorded as a component with UCUM (preferred).",
        "comment": "Used when observation has a set of component observations:\n-  An observation may have both a value (e.g. an  Apgar score) and component observations (the observations from which the Apgar score was derived). \n-  If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- If a value is present, the datatype for this element should be determined by the `code`.\n-  *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 `code` defines a coded value.\n-  *Attachment* is used if the observation result value is a binary file such as an image.  If the observation result value is derived from the binary file (for example \u0027X\u0027 detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.\n- For additional guidance, see the [Notes section](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "condition": [
          "obs-10"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition",
              "valueString": "UCUM units"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "UCUMunits"
            }
          ],
          "strength": "preferred",
          "description": "UCUM units - for recording Vital Signs and components.",
          "valueSet": "http://unitsofmeasure.org/vs"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-2, OBX-5, OBX-6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| \u003c 441742003 |Evaluation finding|"
          }
        ]
      },
      {
        "id": "Observation.component.dataAbsentReason",
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result value is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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  \"test not done\". \n\nThe 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.  Because of these options, use-case agreements are required to interpret general observations for exceptional values.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "obs-10"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component.interpretation",
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "Historically used for laboratory results (known as \u0027abnormal flag\u0027 ),  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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          },
          {
            "identity": "sct-concept",
            "map": "\u003c 260245000 |Findings values|"
          }
        ]
      },
      {
        "id": "Observation.component.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result value",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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\u0027s 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.",
        "requirements": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() \u003e id.count())",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode\u003dREFV]/target[classCode\u003dOBS, moodCode\u003dEVN]"
          }
        ]
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "FHIR Heart Rate Profile",
        "definition": "This profile defines how to represent heart rate observations in FHIR using a standard LOINC code and UCUM units of measure.",
        "constraint": [
          {
            "key": "vs-4",
            "severity": "error",
            "human": "For single vital signs observations (that do not require use of components or hasMember), then either a value[x] or a data absent reason must be present.",
            "expression": "dataAbsentReason.exists() or value.exists()"
          }
        ]
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "short": "Heart Rate",
        "definition": "Heart Rate",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "8867-4"
            }
          ]
        },
        "mustSupport": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VitalSignsHeartRate"
            }
          ],
          "strength": "preferred",
          "description": "This identifies the set of LOINC codes that are appropriate for representing heart rate vital sign measurements in Observation.code.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-vitalsign-heartrate"
        }
      },
      {
        "id": "Observation.valueQuantity",
        "path": "Observation.valueQuantity",
        "condition": [
          "vsp-4"
        ],
        "mustSupport": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/tools/StructureDefinition/binding-definition",
              "valueString": "Common UCUM rate units for vital signs including heart and respiratory rate."
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VitalSignsRateUnits"
            }
          ],
          "strength": "required",
          "description": "/min",
          "valueSet": "http://hl7.org/fhir/ValueSet/ucum-vitalsignsrate"
        }
      },
      {
        "id": "Observation.dataAbsentReason",
        "path": "Observation.dataAbsentReason",
        "condition": [
          "vsp-4"
        ],
        "mustSupport": true
      }
    ]
  }
}