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

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="vitalspanel"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
    <valueMarkdown value="#### Complete Summary of the Mandatory Requirements&#xD;&#xD;1.  One code in `Observation.category` which must have&#xD;    -   a fixed `Observation.category.coding.system`=**'http ://loinc.org'**&#xD;    -   a fixed  `Observation.category.coding.code`= **'85353-1'**&#xD;    -   The code (or codes) for the measurement obtained  in `Observation.code`. All codes&#xD;        SHALL have a system value&#xD;1.  No value in `Observation.value[x]`&#xD;1.  At Least one Vitals Sign Observation reference in `Observation.hasMember`"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="3"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="oo"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="normative"/>
  </extension>
  <extension url="http://hl7.org/fhir/tools/StructureDefinition/profile-summary">
    <valueString value="#### Complete Summary of the Mandatory Requirements&#xD;&#xD;1.  One code in `Observation.category` which must have&#xD;    -   a fixed `Observation.category.coding.system`=**'http ://loinc.org'**&#xD;    -   a fixed  `Observation.category.coding.code`= **'85353-1'**&#xD;    -   The code (or codes) for the measurement obtained  in `Observation.code`. All codes&#xD;        SHALL have a system value&#xD;1.  No value in `Observation.value[x]`&#xD;1.  At Least one Vitals Sign Observation reference in `Observation.hasMember`"/>
  </extension>
  <url value="http://hl7.org/fhir/StructureDefinition/vitalspanel"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.5.1458"/>
  </identifier>
  <version value="6.0.0-ballot4"/>
  <name value="Observationvitalspanel"/>
  <title value="Observation Vital Signs Panel Profile"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2018-08-11"/>
  <publisher value="HL7 International / Orders and Observations"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations"/>
    </telecom>
  </contact>
  <description value="FHIR Vital Signs Panel Profile"/>
  <fhirVersion value="6.0.0-ballot4"/>
  <mapping>
    <identity value="workflow"/>
    <uri value="http://hl7.org/fhir/workflow"/>
    <name value="Workflow Pattern"/>
  </mapping>
  <mapping>
    <identity value="sct-concept"/>
    <uri value="http://snomed.info/conceptdomain"/>
    <name value="SNOMED CT Concept Domain Binding"/>
  </mapping>
  <mapping>
    <identity value="v2"/>
    <uri value="http://hl7.org/v2"/>
    <name value="HL7 V2 Mapping"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM Mapping"/>
  </mapping>
  <mapping>
    <identity value="w5"/>
    <uri value="http://hl7.org/fhir/fivews"/>
    <name value="FiveWs Pattern Mapping"/>
  </mapping>
  <mapping>
    <identity value="sct-attr"/>
    <uri value="http://snomed.org/attributebinding"/>
    <name value="SNOMED CT Attribute Binding"/>
  </mapping>
  <kind value="resource"/>
  <abstract value="false"/>
  <type value="Observation"/>
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>
  <derivation value="constraint"/>
  <snapshot>
    <extension url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
      <valueString value="6.0.0-ballot4"/>
    </extension>
    <element id="Observation">
      <path value="Observation"/>
      <short value="FHIR Vital Signs Panel Profile"/>
      <definition value="This profile defines the top-level grouping structure for a set of vital signs. It has no value in Observation.valueQuantity ; instead, it just includes related links (with type=has-member) to the Observations in this set (e.g. respiratory rate, heart rate, BP - with a minimum of 2 members of the set/panel required)."/>
      <comment value="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 value="Vital Sign"/>
      <alias value="Measurement"/>
      <alias value="Result"/>
      <alias value="Test Performed"/>
      <alias value="Observable"/>
      <alias value="Vital Signs"/>
      <alias value="Results"/>
      <alias value="Tests"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <constraint>
        <key value="dom-2"/>
        <severity value="error"/>
        <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
        <expression value="contained.contained.empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-3"/>
        <severity value="error"/>
        <human value="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 value="contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-4"/>
        <severity value="error"/>
        <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
        <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-5"/>
        <severity value="error"/>
        <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
        <expression value="contained.meta.security.empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
      </constraint>
      <constraint>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown value="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."/>
        </extension>
        <key value="dom-6"/>
        <severity value="warning"/>
        <human value="A resource should have narrative for robust management"/>
        <expression value="text.`div`.exists()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
      </constraint>
      <constraint>
        <key value="obs-6"/>
        <severity value="error"/>
        <human value="Observation.dataAbsentReason SHALL only be present if Observation.value[x] is not present"/>
        <expression value="dataAbsentReason.empty() or value.empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <constraint>
        <key value="obs-7"/>
        <severity value="error"/>
        <human value="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="value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <constraint>
        <key value="obs-10"/>
        <severity value="error"/>
        <human value="Observation.component.dataAbsentReason SHALL only be present if Observation.component.value[x] is not present"/>
        <expression value="component.empty() or component.where(dataAbsentReason.exists()).all(value.empty())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <constraint>
        <key value="obs-11"/>
        <severity value="error"/>
        <human value="if organizer exists and organizer = true, then value[x], dataAbsentReason and component SHALL NOT be present"/>
        <expression value="(organizer.exists() and organizer.allTrue()) implies (value.empty() and dataAbsentReason.empty() and component.empty())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <constraint>
        <key value="obs-12"/>
        <severity value="warning"/>
        <human value="All observations SHOULD have a performer"/>
        <expression value="performer.exists()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <constraint>
        <key value="vsp-1"/>
        <severity value="error"/>
        <human value="if Observation.effective[x] (as dateTime) has a value then that value shall be precise at least to the day"/>
        <expression value="(effective as dateTime).toString().length() &gt;= 8"/>
        <source value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>
      </constraint>
      <constraint>
        <key value="vsp-2"/>
        <severity value="error"/>
        <human value="If there is no component or hasMember element then either a value[x] or a data absent reason must be present."/>
        <expression value="(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/vitalsigns"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Entity, Role, or Act,Observation[classCode=OBS, moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="workflow"/>
        <map value="Event"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="clinical.diagnostics"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 363787002 |Observable entity|"/>
      </mapping>
    </element>
    <element id="Observation.id">
      <path value="Observation.id"/>
      <short value="Logical id of this artifact"/>
      <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="id"/>
        </extension>
        <code value="http://hl7.org/fhirpath/System.String"/>
      </type>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta">
      <path value="Observation.meta"/>
      <short value="Metadata about the resource"/>
      <definition value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.implicitRules">
      <path value="Observation.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition value="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 value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isModifierReason value="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 value="true"/>
    </element>
    <element id="Observation.language">
      <path value="Observation.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language"/>
        </extension>
        <strength value="required"/>
        <description value="IETF language tag for a human language"/>
        <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot4"/>
        <additional>
          <purpose value="starter"/>
          <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
        </additional>
      </binding>
    </element>
    <element id="Observation.text">
      <path value="Observation.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition value="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 &quot;clinically safe&quot; 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 value="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=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-6"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element id="Observation.contained">
      <path value="Observation.contained"/>
      <short value="Contained, inline Resources"/>
      <definition value="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 value="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 value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <condition value="dom-2"/>
      <condition value="dom-4"/>
      <condition value="dom-3"/>
      <condition value="dom-5"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.extension">
      <path value="Observation.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.modifierExtension">
      <path value="Observation.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="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's 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.&#xA;&#xA;Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier"/>
      <short value="Business Identifier for observation"/>
      <definition value="A unique identifier assigned to this observation."/>
      <requirements value="Allows observations to be distinguished and referenced."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.identifier"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.identifier"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="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."/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
    </element>
    <element id="Observation.basedOn">
      <path value="Observation.basedOn"/>
      <short value="Fulfills plan, proposal or order"/>
      <definition value="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 value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon."/>
      <alias value="Fulfills"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.basedOn"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.basedOn"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="ORC"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy">
      <path value="Observation.triggeredBy"/>
      <short value="Triggering observation(s)"/>
      <definition value="Identifies the observation(s) that triggered the performance of this observation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.triggeredBy"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children or both"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="ORC"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.id">
      <path value="Observation.triggeredBy.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/>
        </extension>
        <code value="http://hl7.org/fhirpath/System.String"/>
      </type>
      <condition value="ele-1"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.extension">
      <path value="Observation.triggeredBy.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.modifierExtension">
      <path value="Observation.triggeredBy.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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.&#xA;&#xA;Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="true"/>
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.observation">
      <path value="Observation.triggeredBy.observation"/>
      <short value="Triggering observation"/>
      <definition value="Reference to the triggering observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.triggeredBy.observation"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.type">
      <path value="Observation.triggeredBy.type"/>
      <short value="reflex | repeat | re-run"/>
      <definition value="The type of trigger.&#xA;Reflex | Repeat | Re-run."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.triggeredBy.type"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="TriggeredByType"/>
        </extension>
        <strength value="required"/>
        <description value="The type of TriggeredBy Observation."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-triggeredbytype|6.0.0-ballot4"/>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
    </element>
    <element id="Observation.triggeredBy.reason">
      <path value="Observation.triggeredBy.reason"/>
      <short value="Reason that the observation was triggered"/>
      <definition value="Provides the reason why this observation was performed as a result of the observation(s) referenced."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.triggeredBy.reason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="annotation"/>
      </mapping>
    </element>
    <element id="Observation.partOf">
      <path value="Observation.partOf"/>
      <short value="Part of referenced event"/>
      <definition value="A larger event of which this particular Observation is a component or step.  For example,  an observation as part of a procedure."/>
      <comment value="To link an Observation to an Encounter use `encounter`.  See the  [Notes](observation.html#obsgrouping) below for guidance on referencing another Observation."/>
      <alias value="Container"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.partOf"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationDispense"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationStatement"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.partOf"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="Varies by domain"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=FLFS].target"/>
      </mapping>
    </element>
    <element id="Observation.status">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final"/>
      </extension>
      <path value="Observation.status"/>
      <short value="registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained"/>
      <definition value="The status of the result value."/>
      <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
      <requirements value="Need to track the status of individual results. Some results are finalized before the whole report is finalized."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isModifierReason value="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 value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationStatus"/>
        </extension>
        <strength value="required"/>
        <description value="Codes providing the status of an observation."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-status|6.0.0-ballot4"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.status"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.status"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-11 Map FHIR Observation.status to OBX-11. If FHIR carries Observation.dataAbsentReason = ‘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’."/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct event with a type of &quot;revise&quot;"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 445584004 |Report by finality status|"/>
      </mapping>
    </element>
    <element id="Observation.category">
      <path value="Observation.category"/>
      <slicing>
        <discriminator>
          <type value="pattern"/>
          <path value="$this"/>
        </discriminator>
        <rules value="open"/>
      </slicing>
      <short value="Classification of  type of observation"/>
      <definition value="A code that classifies the general type of observation being made."/>
      <comment value="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 value="Used for filtering what observations are retrieved and displayed."/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Observation.category"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/>
        </extension>
        <strength value="preferred"/>
        <description value="Codes for high level observation categories."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.category"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.class"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-29"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
      </mapping>
    </element>
    <element id="Observation.category:VSCat">
      <path value="Observation.category"/>
      <sliceName value="VSCat"/>
      <short value="Classification of  type of observation"/>
      <definition value="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 value="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 value="Used for filtering what observations are retrieved and displayed."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.category"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <patternCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/observation-category"/>
          <code value="vital-signs"/>
        </coding>
      </patternCodeableConcept>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/>
        </extension>
        <strength value="preferred"/>
        <description value="Codes for high level observation categories."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.category"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.class"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-29"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
      </mapping>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
      <short value="Vital Signs Panel"/>
      <definition value="Vital Signs Panel"/>
      <comment value="*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.&#xA;&#xA;See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop) for additional information."/>
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <alias value="Name"/>
      <alias value="Panel Name"/>
      <alias value="Panel Code"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <patternCodeableConcept>
        <coding>
          <system value="http://loinc.org"/>
          <code value="85353-1"/>
        </coding>
      </patternCodeableConcept>
      <condition value="obs-7"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSignsPanel"/>
        </extension>
        <strength value="preferred"/>
        <description value="This identifies the set of LOINC codes that are appropriate for representing a panel of vital sign measurements in Observation.code."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsign-panel"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|"/>
      </mapping>
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject"/>
      <short value="Who and/or what the observation is about"/>
      <definition value="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 value="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 value="Observations have no value if you don't know who or what they're about."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.subject"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.subject"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=RTGT]"/>
      </mapping>
    </element>
    <element id="Observation.focus">
      <path value="Observation.focus"/>
      <short value="What the observation is about, when it is not about the subject of record"/>
      <definition value="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's record.  The focus of an observation could also be an existing condition,  an intervention, the subject's diet,  another observation of the subject,  or a body structure such as tumor or implanted device.   An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus. As another use case,&#xD;&#xD;a caregiver (RelatedPerson) has back strain and is unable to provide ADL support to a patient (Subject)."/>
      <comment value="Examples demonstrating the use of subject and focus in an Observation:&#xD;&#xD;- A parent is trained to change their child's tracheostomy tube. The child is the subject, and the parent is the focus.&#xD;&#xD;- A fetal heart rate recorded in a mother's record. The mother is the subject, and the fetus is the focus.&#xD;&#xD;- Features of a body structure, such as a tumor. The patient is the subject, and the specific body structure is the focus.&#xD;&#xD;- 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 value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.focus"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isModifierReason value="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 value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SBJ]"/>
      </mapping>
    </element>
    <element id="Observation.organizer">
      <path value="Observation.organizer"/>
      <short value="This observation organizes/groups a set of sub-observations"/>
      <definition value="This observation serves as an organizer or grouper for a set of (one or more) sub-observations."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.organizer"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
      <condition value="obs-11"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.encounter">
      <path value="Observation.encounter"/>
      <short value="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 value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made."/>
      <comment value="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 value="For some observations it may be important to know the link between an observation and a particular encounter."/>
      <alias value="Context"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.encounter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.encounter"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.context"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="PV1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]"/>
      <short value="Vital Signs are point in time measurements and are recorded using the dateTime data type"/>
      <definition value="Vital Signs are point in time measurements and are recorded using the dateTime data type."/>
      <comment value="At least a date should be present unless this observation is a historical report.  For recording imprecise or &quot;fuzzy&quot; times (For example, a blood glucose measurement taken &quot;after breakfast&quot;) use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events."/>
      <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining trends."/>
      <alias value="Occurrence"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.effective[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <condition value="vsp-1"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.occurrence[x]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.done[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-14 (If Observation carries the AnalysisDateTime extension, then map the extension to OBX-19)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="effectiveTime"/>
      </mapping>
    </element>
    <element id="Observation.issued">
      <path value="Observation.issued"/>
      <short value="Date/Time this version was made available"/>
      <definition value="The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified."/>
      <comment value="For Observations that don't 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't require the new version to be reviewed and verified again."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.issued"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="instant"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.recorded"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBR-22 (or MSH-7), or perhaps OBX-19 (depends on who observation made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=AUT].time"/>
      </mapping>
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer"/>
      <short value="Who is responsible for the observation"/>
      <definition value="Who was responsible for asserting the observed value as &quot;true&quot;."/>
      <comment value="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 value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.performer"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CareTeam"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/HealthcareService"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.performer.actor"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.actor"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="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)."/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=PRF]"/>
      </mapping>
    </element>
    <element id="Observation.value[x]">
      <path value="Observation.value[x]"/>
      <short value="The quantity for the vital sign being observed."/>
      <definition value="The quantity for the vital sign being observed."/>
      <comment value="- An observation may have:&#xA;  1.  a single value here&#xA;  1.  both a value and a set of related or component values&#xA;  1.  only a set of related or component values.&#xA;-  If a value is present, the datatype for this element should be determined by the `code`.&#xA;-  *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.&#xA;-  *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 'X' detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.&#xA;- For additional guidance, see the [Notes section](observation.html#notes) below. &#xA;- See [Interoperability Issues using code value pairs in FHIR](observation.html#code-interop) for additional information."/>
      <requirements value="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 value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-7"/>
      <condition value="obs-6"/>
      <condition value="obs-11"/>
      <condition value="vsp-2"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSignsUnits"/>
        </extension>
        <strength value="preferred"/>
        <description value="Commonly encountered UCUM units for recording Vital Signs."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/ucum-vitals-common"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-2, OBX-5, OBX-6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363714003 |Interprets|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 441742003 |Evaluation finding|"/>
      </mapping>
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/>
      <short value="Why the result value is missing"/>
      <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
      <comment value="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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   &#xA;&#xA;The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code &quot;error&quot; could be used when the measurement was not completed."/>
      <requirements value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-6"/>
      <condition value="obs-11"/>
      <condition value="vsp-2"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-32, OBX-11. Map Observation.dataAbsentReason to OBX-32 (Observation Value Absent Reason). Additionally, when dataAbsentReason.code = 'not-asked', also set OBX-11 = 'N'."/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element id="Observation.interpretation">
      <path value="Observation.interpretation"/>
      <short value="High, low, normal, etc"/>
      <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/>
      <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use extends to other use cases where coded interpretations  are relevant.  Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."/>
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
      <alias value="Abnormal Flag"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.interpretation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363713009 |Has interpretation|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values|"/>
      </mapping>
    </element>
    <element id="Observation.interpretationContext">
      <path value="Observation.interpretationContext"/>
      <short value="Context for understanding the observation"/>
      <definition value="Other preceding or concurrent information that is critical to understand the context and significance of the observation."/>
      <comment value="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 value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.interpretationContext"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableReference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretationContext"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying contextual factors that affect interpretation of observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation-context"/>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=PERT].target"/>
      </mapping>
    </element>
    <element id="Observation.note">
      <path value="Observation.note"/>
      <short value="Comments about the observation"/>
      <definition value="Comments about the observation or the results."/>
      <comment value="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 value="Need to be able to provide free text additional information."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.note"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.note"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="NTE-3 (partner NTE to OBX, or sometimes another (child?) OBX)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/>
      </mapping>
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite"/>
      <short value="DEPRECATED: Observed body part"/>
      <definition value="DEPRECATED: This element is deprecated. Use bodyStructure instead. Indicates the site on the subject's body where the observation was made (i.e. the target site)."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.bodySite"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="718497002 |Inherent location|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 123037004 |Body structure|"/>
      </mapping>
    </element>
    <element id="Observation.bodyStructure">
      <path value="Observation.bodyStructure"/>
      <short value="Observed body structure"/>
      <definition value="Indicates the body structure on the subject's body where the observation was made (i.e. the target site)."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.bodyStructure"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableReference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/BodyStructure"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BodyStructure"/>
        </extension>
        <strength value="example"/>
        <description value="SNOMED CT Body Structures"/>
        <valueSet value="http://hl7.org/fhir/ValueSet/body-site"/>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
    </element>
    <element id="Observation.method">
      <path value="Observation.method"/>
      <short value="How it was done"/>
      <definition value="Indicates the mechanism used to perform the observation."/>
      <comment value="Only used if not implicit in code for Observation.code."/>
      <requirements value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.method"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationMethod"/>
        </extension>
        <strength value="example"/>
        <description value="Methods for simple observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-methods"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="methodCode"/>
      </mapping>
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen"/>
      <short value="Specimen used for this observation"/>
      <definition value="The specimen that was used when this observation was made."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.specimen"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="obs-9"/>
        <severity value="error"/>
        <human value="If Observation.specimen is a reference to Group, the group can only have specimens"/>
        <expression value="(reference.resolve().exists() and reference.resolve() is Group) implies reference.resolve().member.entity.resolve().all($this is Specimen)"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="SPM segment (OBX-33 for Specimen.identifier mapping)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SPC].specimen"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="704319004 |Inherent in|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 123038009 |Specimen|"/>
      </mapping>
    </element>
    <element id="Observation.device">
      <path value="Observation.device"/>
      <short value="A reference to the device that generates the measurements or the device settings for the device"/>
      <definition value="A reference to the device that generates the measurements or the device settings for the device."/>
      <comment value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.device"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-18 / PRT -10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=DEV]"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="424226004 |Using device|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 49062001 |Device|"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/>
      <short value="Provides guide for interpretation"/>
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range.  Multiple reference ranges are interpreted as an &quot;OR&quot;.   In other words, to represent two distinct target populations, two `referenceRange` elements would be used."/>
      <comment value="Most observations only have one generic reference range. Systems MAY choose to restrict to only        supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age,        gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference        range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children or both"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="obs-3"/>
        <severity value="error"/>
        <human value="Must have at least a low or a high or text"/>
        <expression value="low.exists() or high.exists() or text.exists()"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.id">
      <path value="Observation.referenceRange.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/>
        </extension>
        <code value="http://hl7.org/fhirpath/System.String"/>
      </type>
      <condition value="ele-1"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.extension">
      <path value="Observation.referenceRange.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.modifierExtension">
      <path value="Observation.referenceRange.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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.&#xA;&#xA;Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="true"/>
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.low">
      <path value="Observation.referenceRange.low"/>
      <short value="Low Range, if relevant"/>
      <definition value="The value of the low bound of the reference range."/>
      <comment value="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        '&gt;=5' - '&lt;=9').  Alternatively, this can be specified explicitly by populating low.comparator = '&gt;='.         When the low bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range        is '&gt;5' - '&lt;9'), this is specified with low.comparator = '&gt;'.  If the low bound is omitted,  it is        assumed to be meaningless (e.g., reference range is '&lt;=2.3')."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.low"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-3"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="obs-13"/>
        <severity value="error"/>
        <human value="If low.comparator exists, it must be '&gt;=' or '&gt;'."/>
        <expression value="comparator.exists() implies (comparator = '&gt;=' or comparator = '&gt;')"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.low"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.high">
      <path value="Observation.referenceRange.high"/>
      <short value="High Range, if relevant"/>
      <definition value="The value of the high bound of the reference range."/>
      <comment value="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        '&gt;=5' - '&lt;=9').  Alternatively, this can be specified explicitly by populating high.comparator = '&lt;='.         When the high bound of the reference range endpoint is intended to be exclusive of the value (e.g., reference range        is '&gt;5' - '&lt;9'), this is specified with high.comparator = '&lt;'.  If the high bound is omitted,  it is        assumed to be meaningless (e.g., reference range is '&gt;=2.3')."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.high"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-3"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="obs-14"/>
        <severity value="error"/>
        <human value="If high.comparator exists, it must be '&lt;=' or '&lt;'."/>
        <expression value="comparator.exists() implies (comparator = '&lt;=' or comparator = '&lt;')"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.high"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.normalValue">
      <path value="Observation.referenceRange.normalValue"/>
      <short value="Normal value, if relevant"/>
      <definition value="The value of the normal value of the reference range."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.normalValue"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationReferenceRangeNormalValue"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying the normal value of the observation."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-referencerange-normalvalue"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.normal"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.type">
      <path value="Observation.referenceRange.type"/>
      <short value="Reference range qualifier"/>
      <definition value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range."/>
      <comment value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed."/>
      <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc.,  - for proper interpretation."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.type"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/>
        </extension>
        <strength value="preferred"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values| OR  &#xD;&lt; 365860008 |General clinical state finding| &#xD;OR &#xD;&lt; 250171008 |Clinical history or observation findings| OR  &#xD;&lt; 415229000 |Racial group| OR &#xD;&lt; 365400002 |Finding of puberty stage| OR&#xD;&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.appliesTo">
      <path value="Observation.referenceRange.appliesTo"/>
      <short value="Reference range population"/>
      <definition value="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 &quot;AND&quot; 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 value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed."/>
      <requirements value="Need to be able to identify the target population for proper interpretation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange.appliesTo"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying the population the reference range applies to."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values| OR  &#xD;&lt; 365860008 |General clinical state finding| &#xD;OR &#xD;&lt; 250171008 |Clinical history or observation findings| OR  &#xD;&lt; 415229000 |Racial group| OR &#xD;&lt; 365400002 |Finding of puberty stage| OR&#xD;&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.age">
      <path value="Observation.referenceRange.age"/>
      <short value="Applicable age range, if relevant"/>
      <definition value="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 value="Some analytes vary greatly over age."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.age"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Range"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.text">
      <path value="Observation.referenceRange.text"/>
      <short value="Text based reference range in an observation"/>
      <definition value="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 &quot;Negative&quot; or a list or table of &quot;normals&quot;."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="markdown"/>
      </type>
      <condition value="obs-3"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:ST"/>
      </mapping>
    </element>
    <element id="Observation.hasMember">
      <path value="Observation.hasMember"/>
      <short value="Used when reporting observations included in a vital signs panel"/>
      <definition value="Used when reporting observations included in a vital signs panel."/>
      <comment value="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 value="2"/>
      <max value="*"/>
      <base>
        <path value="Observation.hasMember"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element id="Observation.derivedFrom">
      <path value="Observation.derivedFrom"/>
      <short value="Related resource from which the observation is made"/>
      <definition value="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 value="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 value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.derivedFrom"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="Observation.component">
      <path value="Observation.component"/>
      <short value="Component results"/>
      <definition value="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 value="For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below."/>
      <requirements value="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 value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <condition value="obs-7"/>
      <condition value="obs-11"/>
      <condition value="obs-10"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children or both"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="containment by OBX-4?"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship[typeCode=COMP]"/>
      </mapping>
    </element>
    <element id="Observation.component.id">
      <path value="Observation.component.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/>
        </extension>
        <code value="http://hl7.org/fhirpath/System.String"/>
      </type>
      <condition value="ele-1"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.extension">
      <path value="Observation.component.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.modifierExtension">
      <path value="Observation.component.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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.&#xA;&#xA;Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment value="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 value="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 value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <isModifier value="true"/>
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.component.code">
      <path value="Observation.component.code"/>
      <short value="Vital Sign measurement or component"/>
      <definition value="Vital Sign measurement or component."/>
      <comment value="*All* code-value and  component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation."/>
      <requirements value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-7"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCode"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes-observationorboth"/>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 363787002 |Observable entity| OR &#xD;&lt; 386053000 |Evaluation procedure|"/>
      </mapping>
    </element>
    <element id="Observation.component.value[x]">
      <path value="Observation.component.value[x]"/>
      <slicing>
        <discriminator>
          <type value="type"/>
          <path value="$this"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="The value for the vital sign component being observed."/>
      <definition value="The value for the vital sign component being observed."/>
      <comment value="Used when observation has a set of component observations:&#xA;-  An observation may have both a value (e.g. an  Apgar score) and component observations (the observations from which the Apgar score was derived). &#xA;-  If a value is present, the datatype for this element should be determined by the `code`.&#xA;-  *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.&#xA;-  *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 'X' detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.&#xA;- If a value is present, the datatype for this element should be determined by the `code`.&#xA;-  *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.&#xA;-  *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 'X' detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.&#xA;- For additional guidance, see the [Notes section](observation.html#notes) below."/>
      <requirements value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="boolean"/>
      </type>
      <type>
        <code value="integer"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <type>
        <code value="Attachment"/>
      </type>
      <condition value="obs-10"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-2, OBX-5, OBX-6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363714003 |Interprets|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>
      </mapping>
    </element>
    <element id="Observation.component.value[x]:valueQuantity">
      <path value="Observation.component.value[x]"/>
      <sliceName value="valueQuantity"/>
      <short value="Vital Sign component value recorded as a component with UCUM (preferred)"/>
      <definition value="Vital Sign component value recorded as a component with UCUM (preferred)."/>
      <comment value="Used when observation has a set of component observations:&#xA;-  An observation may have both a value (e.g. an  Apgar score) and component observations (the observations from which the Apgar score was derived). &#xA;-  If a value is present, the datatype for this element should be determined by the `code`.&#xA;-  *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.&#xA;-  *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 'X' detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.&#xA;- If a value is present, the datatype for this element should be determined by the `code`.&#xA;-  *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.&#xA;-  *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 'X' detected and here is the the proof in this image), the binary file may be directly represented using *DocumentReference* and referenced by `derivedFrom`.&#xA;- For additional guidance, see the [Notes section](observation.html#notes) below."/>
      <requirements value="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 value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <condition value="obs-10"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/tools/StructureDefinition/binding-definition">
          <valueString value="UCUM units"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="UCUMunits"/>
        </extension>
        <strength value="preferred"/>
        <description value="UCUM units - for recording Vital Signs and components."/>
        <valueSet value="http://unitsofmeasure.org/vs"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-2, OBX-5, OBX-6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363714003 |Interprets|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>
      </mapping>
    </element>
    <element id="Observation.component.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason"/>
      <short value="Why the component result value is missing"/>
      <definition value="Provides a reason why the expected value in the element Observation.component.value[x] is missing."/>
      <comment value="&quot;Null&quot; 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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;. &#xA;&#xA;The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code &quot;error&quot; 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 value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-10"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes specifying why the result (`Observation.value[x]`) is missing."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element id="Observation.component.interpretation">
      <path value="Observation.component.interpretation"/>
      <short value="High, low, normal, etc"/>
      <definition value="A categorical assessment of an observation value.  For example, high, low, normal."/>
      <comment value="Historically used for laboratory results (known as 'abnormal flag' ),  its use extends to other use cases where coded interpretations  are relevant.  Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."/>
      <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
      <alias value="Abnormal Flag"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.interpretation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363713009 |Has interpretation|"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values|"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/>
      <short value="Provides guide for interpretation of component result value"/>
      <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
      <comment value="Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <contentReference value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange"/>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element id="Observation">
      <path value="Observation"/>
      <short value="FHIR Vital Signs Panel Profile"/>
      <definition value="This profile defines the top-level grouping structure for a set of vital signs. It has no value in Observation.valueQuantity ; instead, it just includes related links (with type=has-member) to the Observations in this set (e.g. respiratory rate, heart rate, BP - with a minimum of 2 members of the set/panel required)."/>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
      <short value="Vital Signs Panel"/>
      <definition value="Vital Signs Panel"/>
      <alias value="Panel Name"/>
      <alias value="Panel Code"/>
      <patternCodeableConcept>
        <coding>
          <system value="http://loinc.org"/>
          <code value="85353-1"/>
        </coding>
      </patternCodeableConcept>
      <mustSupport value="true"/>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="VitalSignsPanel"/>
        </extension>
        <strength value="preferred"/>
        <description value="This identifies the set of LOINC codes that are appropriate for representing a panel of vital sign measurements in Observation.code."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-vitalsign-panel"/>
      </binding>
    </element>
    <element id="Observation.value[x]">
      <path value="Observation.value[x]"/>
      <max value="0"/>
    </element>
    <element id="Observation.hasMember">
      <path value="Observation.hasMember"/>
      <min value="2"/>
      <mustSupport value="true"/>
    </element>
  </differential>
</StructureDefinition>