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10.1.18.2 StructureDefinition: Observationvitalsignsbase

Orders and Observations icon Work Group  Maturity Level: 0 Trial Use Use Context: Any

The canonical URL for this profile is: 

http://hl7.org/fhir/StructureDefinition/vitalsigns

FHIR Vital Signs Base Profile

This profile was published on Sat, Aug 11, 2018 00:00+0000 as a draft by HL7 International / Orders and Observations.

10.1.18.2.1 Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Observation.

Summary

10.1.18.2.2 Complete Summary of the Mandatory Requirements

  1. One status in Observation.status which has a required binding to:

  2. A category in Observation.category which must have:

    • a fixed Observation.category.coding.system="http://terminology.hl7.org/CodeSystem/observation-category"
    • a fixed Observation.category.coding.code= "vital-signs"

  3. A code in Observation.code

    • a fixed Observation.code.coding.system= "http://loinc.org""
    • a LOINC code in Observation.code.coding.code which has an extensible binding to:

  4. One patient in Observation.subject

  5. A date and time in effectiveDateTime or effectivePeriod

  6. Either one Observation.value[x] or a populated component (with component.code and component.value[x]), if there is no value, one code in Observation.DataAbsentReason

    • if a vital sign measure then:
      • One numeric value in Observation.valueQuantity.value
      • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
      • a UCUM unit code in Observation.valueQuantity.code which has a required binding to the Vital Signs Units value set.
    • Observation.DataAbsentReason is bound to Observation Value Absent Reason value set.

  7. When using a panel code to group component observations (Note: See the comments regarding blood pressure in the table above), one or more Observation.component.code each of which must have:

    • a fixed Observation.component.code.coding.system =""http://loinc.org""

  8. Either one Observation.component.valueQuantity or, if there is no value, one code in Observation.component.DataAbsentReason

  9. When using a panel code to group observations, one or more reference to Vitals Signs Observations in Observation.related.target

    • a fixed Observation.related.type= "has-member""

Mandatory: 6 elements (+1 nested mandatory element)
Must-Support: 14 elements

Slices

This structure defines the following Slices:

  • The element Observation.category is sliced based on the value of pattern:$this

This indicates the differences between this profile and the base Observation structure.

Name iconFlags iconCard. iconType iconDescription & Constraints icondoco icon
.. Observation C icon 0..* Observation FHIR Vital Signs Base Profile
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... status S 1..1 code registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
Binding: Observation Status (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: Vital Signs Category (preferred): This value set includes the required vital sign interoperability categories.

.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S 1..1 CodeableConcept Vital Sign Measurement
Binding: Vital Signs Measurement (preferred): This identifies the vital sign measurement.

... subject S 1..1 Reference(Patient) Who and/or what the observation is about
... effective[x] SC icon 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... value[x] SC icon 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period, Attachment, Reference(MolecularSequence) Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
... valueQuantity S 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs.

... dataAbsentReason SC icon 0..1 CodeableConcept Why the result value is missing
... hasMember 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Used when reporting vital signs panel components
... derivedFrom 0..* Reference(DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Related resource from which the observation is made
... component SC icon 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... code S 1..1 CodeableConcept Type of component observation (code / type)
Binding: Vital Signs Component Measurement (preferred): This identifies the vital sign component measurement.

.... value[x] SC icon 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period, Attachment, Reference(MolecularSequence) Vital Sign Value
.... valueQuantity S 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs Components.

.... dataAbsentReason SC icon 0..1 CodeableConcept Why the component result value is missing

doco Documentation for this format icon

This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Observation structure.

Name iconFlags iconCard. iconType iconDescription & Constraints icondoco icon
.. Observation C icon 0..* Observation FHIR Vital Signs Base Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: 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).
obs-8: bodyStructure SHALL only be present if Observation.bodySite is not present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: All Languages (required): IETF language tag for a human language

Additional BindingsPurpose
Common Languages Starter Set
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... instantiates[x] Σ 0..1 canonical(ObservationDefinition), Reference(ObservationDefinition) Instantiates FHIR ObservationDefinition
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... triggeredBy 0..* BackboneElement Triggering observation(s)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... observation Σ 1..1 Reference(Observation) Triggering observation
.... type Σ 1..1 code reflex | repeat | re-run
Binding: triggered Bytype (required): The type of TriggeredBy Observation.

.... reason 0..1 string Reason that the observation was triggered
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
Binding: Observation Status (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: Vital Signs Category (preferred): This value set includes the required vital sign interoperability categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: Observation Category Codes (preferred): Codes for high level observation categories.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣC icon 1..1 CodeableConcept Vital Sign Measurement
Binding: Vital Signs Measurement (preferred): This identifies the vital sign measurement.

... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... focus ?!Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣC icon 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC icon 0..1 Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... valueAttachment Attachment
.... valueReference Reference(MolecularSequence)
.... value[x]:valueQuantity SΣC icon 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs.

... dataAbsentReason SC icon 0..1 CodeableConcept Why the result value is missing
Binding: Data Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..* CodeableConcept High, low, normal, etc
Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.


... note 0..* Annotation Comments about the observation
... bodySite C icon 0..1 CodeableConcept Observed body part
Binding: SNOMED CT Body Structures (example): SNOMED CT Body site concepts

... bodyStructure C icon 0..1 Reference(BodyStructure) Observed body structure
... method 0..1 CodeableConcept How it was done
Binding: Observation Methods (example): Methods for simple observations.

... specimen C icon 0..1 Reference(Specimen | Group) Specimen used for this observation
obs-9: If Observation.specimen is a reference to Group, the group can only have specimens
... device 0..1 Reference(Device | DeviceMetric) A reference to the device that generates the measurements or the device settings for the device
... referenceRange C icon 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C icon 0..1 SimpleQuantity Low Range, if relevant
.... high C icon 0..1 SimpleQuantity High Range, if relevant
.... normalValue 0..1 CodeableConcept Normal value, if relevant
Binding: Observation Reference Range Normal Value Codes (extensible): Codes identifying the normal value of the observation.

.... type 0..1 CodeableConcept Reference range qualifier
Binding: Observation Reference Range Meaning Codes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..* CodeableConcept Reference range population
Binding: Observation Reference Range Applies To Codes (example): Codes identifying the population the reference range applies to.


.... age 0..1 Range Applicable age range, if relevant
.... text C icon 0..1 markdown Text based reference range in an observation
... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Related resource from which the observation is made
... component SΣC icon 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣC icon 1..1 CodeableConcept Type of component observation (code / type)
Binding: Vital Signs Component Measurement (preferred): This identifies the vital sign component measurement.

.... Slices for value[x] SΣC icon 0..1 Vital Sign Value
Slice: Unordered, Open by type:$this
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
..... valueAttachment Attachment
..... valueReference Reference(MolecularSequence)
..... value[x]:valueQuantity SΣ 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs Components.

.... dataAbsentReason SC icon 0..1 CodeableConcept Why the component result value is missing
Binding: Data Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..* CodeableConcept High, low, normal, etc
Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result value

doco Documentation for this format icon
<!-- Observationvitalsignsbase -->doco

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- I 0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!-- I 0..1 Language of the resource content   -->
 <text><!-- I 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 
     Business Identifier for observation --></identifier>
 <instantiates[x]><!-- I 0..1 canonical|Reference(ObservationDefinition) 
     Instantiates FHIR ObservationDefinition --></instantiates[x]>
 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <type value="[code]"/><!-- I 1..1 reflex | repeat | re-run   -->
  <reason value="[string]"/><!-- I 0..1 Reason that the observation was triggered -->
 </triggeredBy>
 <partOf><!-- I 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- I 1..1 registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained   -->
 <-- category sliced by pattern:$this  in the specified orderOpen-->
 <category><!-- I 1..1 CodeableConcept Classification of  type of observation   --></category>
 <code><!-- I 1..1 CodeableConcept Vital Sign Measurement   --></code>
 <subject><!-- I 1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!-- I 0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!-- I 0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <effective[x]><!-- I 1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!-- I 0..1 Date/Time this version was made available -->
 <performer><!-- I 0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <-- value[x] sliced by type:$this  in the specified orderOpen-->
 <valueQuantity><!-- I 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)   --></valueQuantity>
 <dataAbsentReason><!-- I 0..1 CodeableConcept Why the result value is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <bodySite><!-- I 0..1 CodeableConcept Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 Reference(BodyStructure) Observed body structure --></bodyStructure>
 <method><!-- I 0..1 CodeableConcept How it was done   --></method>
 <specimen><!-- I 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- I 0..1 Reference(Device) 
     A reference to the device that generates the measurements or the device settings for the device --></device>
 <referenceRange> I 0..* BackboneElement  <!-- I 0..* Provides guide for interpretation -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <low><!-- I 0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!-- I 0..1 Quantity 
      High Range, if relevant --></high>
  <normalValue><!-- I 0..1 CodeableConcept Normal value, if relevant   --></normalValue>
  <type><!-- I 0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!-- I 0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!-- I 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[markdown]"/><!-- I 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- I 0..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!-- I 1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <-- value[x] sliced by type:$this  in the specified orderOpen-->
  <valueQuantity><!-- I 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)   --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result value is missing   --></dataAbsentReason>
  <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result value --></referenceRange>
 </component>
</Observation>

{ // Observationvitalsignsbase
  // from Element: extension
    "meta" : { Meta }, // IMetadata about the resource
    "implicitRules" : "<uri>", // IA set of rules under which this content was created
    "language" : "<code>", // ILanguage of the resource content
    "text" : { Narrative }, // IText summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation
  // value[x]: Instantiates FHIR ObservationDefinition. One of these 2:
    "instantiatesCanonical" : "<canonical>", // IInstantiates FHIR ObservationDefinition
    "instantiatesReference" : { Reference(ObservationDefinition) }, // IInstantiates FHIR ObservationDefinition
    "basedOn" : [{ Reference(CarePlan) }], // IFulfills plan, proposal or order
    "triggeredBy" : [{ BackboneElement }], // ITriggering observation(s)
    "partOf" : [{ Reference(MedicationAdministration) }], // IPart of referenced event
    "status" : "<code>", // I R! registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
    "category" : [ //  sliced by pattern:$this  in the specified order, Open 
      { // Classification of  type of observation // I R! 
        // from Element: extension
      }
    ],
    "code" : { CodeableConcept }, // I R! Vital Sign Measurement
    "subject" : { Reference(Patient) }, // I R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // IWhat the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // IHealthcare event during which this observation is made
  // value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // I R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // I R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
    "valueQuantity" : [ //  sliced by type:$this  in the specified order, Open 
      { // Vital Sign Value recorded with UCUM (preferred) // I
        // from Element: extension
      }
    ],
    "dataAbsentReason" : { CodeableConcept }, // IWhy the result value is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "note" : [{ Annotation }], // IComments about the observation
    "bodySite" : { CodeableConcept }, // IObserved body part
    "bodyStructure" : { Reference(BodyStructure) }, // IObserved body structure
    "method" : { CodeableConcept }, // IHow it was done
    "specimen" : { Reference(Specimen) }, // ISpecimen used for this observation
    "device" : { Reference(Device) }, // IA reference to the device that generates the measurements or the device settings for the device
    "referenceRange" : [{ BackboneElement }], // IProvides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // IUsed when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IUsed when reporting systolic and diastolic blood pressure.
  }

This structure is derived from Observation.

Summary

10.1.18.2.3 Complete Summary of the Mandatory Requirements

  1. One status in Observation.status which has a required binding to:

  2. A category in Observation.category which must have:

    • a fixed Observation.category.coding.system="http://terminology.hl7.org/CodeSystem/observation-category"
    • a fixed Observation.category.coding.code= "vital-signs"

  3. A code in Observation.code

    • a fixed Observation.code.coding.system= "http://loinc.org""
    • a LOINC code in Observation.code.coding.code which has an extensible binding to:

  4. One patient in Observation.subject

  5. A date and time in effectiveDateTime or effectivePeriod

  6. Either one Observation.value[x] or a populated component (with component.code and component.value[x]), if there is no value, one code in Observation.DataAbsentReason

    • if a vital sign measure then:
      • One numeric value in Observation.valueQuantity.value
      • a fixed Observation.valueQuantity.system="http://unitsofmeasure.org"
      • a UCUM unit code in Observation.valueQuantity.code which has a required binding to the Vital Signs Units value set.
    • Observation.DataAbsentReason is bound to Observation Value Absent Reason value set.

  7. When using a panel code to group component observations (Note: See the comments regarding blood pressure in the table above), one or more Observation.component.code each of which must have:

    • a fixed Observation.component.code.coding.system =""http://loinc.org""

  8. Either one Observation.component.valueQuantity or, if there is no value, one code in Observation.component.DataAbsentReason

  9. When using a panel code to group observations, one or more reference to Vitals Signs Observations in Observation.related.target

    • a fixed Observation.related.type= "has-member""

Mandatory: 6 elements (+1 nested mandatory element)
Must-Support: 14 elements

Slices

This structure defines the following Slices:

  • The element Observation.category is sliced based on the value of pattern:$this

Differential View

This indicates the differences between this profile and the base Observation structure.

Name iconFlags iconCard. iconType iconDescription & Constraints icondoco icon
.. Observation C icon 0..* Observation FHIR Vital Signs Base Profile
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... status S 1..1 code registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
Binding: Observation Status (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: Vital Signs Category (preferred): This value set includes the required vital sign interoperability categories.

.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code S 1..1 CodeableConcept Vital Sign Measurement
Binding: Vital Signs Measurement (preferred): This identifies the vital sign measurement.

... subject S 1..1 Reference(Patient) Who and/or what the observation is about
... effective[x] SC icon 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... value[x] SC icon 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period, Attachment, Reference(MolecularSequence) Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
... valueQuantity S 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs.

... dataAbsentReason SC icon 0..1 CodeableConcept Why the result value is missing
... hasMember 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Used when reporting vital signs panel components
... derivedFrom 0..* Reference(DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Related resource from which the observation is made
... component SC icon 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... code S 1..1 CodeableConcept Type of component observation (code / type)
Binding: Vital Signs Component Measurement (preferred): This identifies the vital sign component measurement.

.... value[x] SC icon 0..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period, Attachment, Reference(MolecularSequence) Vital Sign Value
.... valueQuantity S 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs Components.

.... dataAbsentReason SC icon 0..1 CodeableConcept Why the component result value is missing

doco Documentation for this format icon

Snapshot View

This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Observation structure.

Name iconFlags iconCard. iconType iconDescription & Constraints icondoco icon
.. Observation C icon 0..* Observation FHIR Vital Signs Base Profile
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: 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).
obs-8: bodyStructure SHALL only be present if Observation.bodySite is not present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: All Languages (required): IETF language tag for a human language

Additional BindingsPurpose
Common Languages Starter Set
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... instantiates[x] Σ 0..1 canonical(ObservationDefinition), Reference(ObservationDefinition) Instantiates FHIR ObservationDefinition
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... triggeredBy 0..* BackboneElement Triggering observation(s)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... observation Σ 1..1 Reference(Observation) Triggering observation
.... type Σ 1..1 code reflex | repeat | re-run
Binding: triggered Bytype (required): The type of TriggeredBy Observation.

.... reason 0..1 string Reason that the observation was triggered
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy | GenomicStudy) Part of referenced event
... status ?!SΣ 1..1 code registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
Binding: Observation Status (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: Vital Signs Category (preferred): This value set includes the required vital sign interoperability categories.


.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: Observation Category Codes (preferred): Codes for high level observation categories.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣC icon 1..1 CodeableConcept Vital Sign Measurement
Binding: Vital Signs Measurement (preferred): This identifies the vital sign measurement.

... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... focus ?!Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣC icon 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC icon 0..1 Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... valueAttachment Attachment
.... valueReference Reference(MolecularSequence)
.... value[x]:valueQuantity SΣC icon 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs.

... dataAbsentReason SC icon 0..1 CodeableConcept Why the result value is missing
Binding: Data Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..* CodeableConcept High, low, normal, etc
Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.


... note 0..* Annotation Comments about the observation
... bodySite C icon 0..1 CodeableConcept Observed body part
Binding: SNOMED CT Body Structures (example): SNOMED CT Body site concepts

... bodyStructure C icon 0..1 Reference(BodyStructure) Observed body structure
... method 0..1 CodeableConcept How it was done
Binding: Observation Methods (example): Methods for simple observations.

... specimen C icon 0..1 Reference(Specimen | Group) Specimen used for this observation
obs-9: If Observation.specimen is a reference to Group, the group can only have specimens
... device 0..1 Reference(Device | DeviceMetric) A reference to the device that generates the measurements or the device settings for the device
... referenceRange C icon 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C icon 0..1 SimpleQuantity Low Range, if relevant
.... high C icon 0..1 SimpleQuantity High Range, if relevant
.... normalValue 0..1 CodeableConcept Normal value, if relevant
Binding: Observation Reference Range Normal Value Codes (extensible): Codes identifying the normal value of the observation.

.... type 0..1 CodeableConcept Reference range qualifier
Binding: Observation Reference Range Meaning Codes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..* CodeableConcept Reference range population
Binding: Observation Reference Range Applies To Codes (example): Codes identifying the population the reference range applies to.


.... age 0..1 Range Applicable age range, if relevant
.... text C icon 0..1 markdown Text based reference range in an observation
... hasMember Σ 0..* Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Used when reporting vital signs panel components
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | QuestionnaireResponse | MolecularSequence | Vital Signs Base Profile) Related resource from which the observation is made
... component SΣC icon 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣC icon 1..1 CodeableConcept Type of component observation (code / type)
Binding: Vital Signs Component Measurement (preferred): This identifies the vital sign component measurement.

.... Slices for value[x] SΣC icon 0..1 Vital Sign Value
Slice: Unordered, Open by type:$this
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
..... valueAttachment Attachment
..... valueReference Reference(MolecularSequence)
..... value[x]:valueQuantity SΣ 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)
Binding: Vital Signs Units (preferred): Commonly encountered UCUM units for recording Vital Signs Components.

.... dataAbsentReason SC icon 0..1 CodeableConcept Why the component result value is missing
Binding: Data Absent Reason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..* CodeableConcept High, low, normal, etc
Binding: Observation Interpretation Codes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result value

doco Documentation for this format icon

XML Template

<!-- Observationvitalsignsbase -->doco

<Observation xmlns="http://hl7.org/fhir"
>
  <!-- from Element: extension -->
 <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
 <meta><!-- I 0..1 Meta Metadata about the resource --></meta>
 <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created -->
 <language value="[code]"/><!-- I 0..1 Language of the resource content   -->
 <text><!-- I 0..1 Narrative 
     Text summary of the resource, for human interpretation --></text>
 <contained><!-- 0..* Resource Contained, inline Resources --></contained>
 <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- I 0..* Identifier 
     Business Identifier for observation --></identifier>
 <instantiates[x]><!-- I 0..1 canonical|Reference(ObservationDefinition) 
     Instantiates FHIR ObservationDefinition --></instantiates[x]>
 <basedOn><!-- I 0..* Reference(CarePlan) Fulfills plan, proposal or order --></basedOn>
 <triggeredBy> I 0..* BackboneElement  <!-- I 0..* Triggering observation(s) -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <observation><!-- I 1..1 Reference(Observation) 
      Triggering observation --></observation>
  <type value="[code]"/><!-- I 1..1 reflex | repeat | re-run   -->
  <reason value="[string]"/><!-- I 0..1 Reason that the observation was triggered -->
 </triggeredBy>
 <partOf><!-- I 0..* Reference(MedicationAdministration) Part of referenced event --></partOf>
 <status value="[code]"/><!-- I 1..1 registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained   -->
 <-- category sliced by pattern:$this  in the specified orderOpen-->
 <category><!-- I 1..1 CodeableConcept Classification of  type of observation   --></category>
 <code><!-- I 1..1 CodeableConcept Vital Sign Measurement   --></code>
 <subject><!-- I 1..1 Reference(Patient) 
     Who and/or what the observation is about --></subject>
 <focus><!-- I 0..* Reference(Resource) 
     What the observation is about, when it is not about the subject of record --></focus>
 <encounter><!-- I 0..1 Reference(Encounter) 
     Healthcare event during which this observation is made --></encounter>
 <effective[x]><!-- I 1..1 dateTime|Period 
     Often just a dateTime for Vital Signs --></effective[x]>
 <issued value="[instant]"/><!-- I 0..1 Date/Time this version was made available -->
 <performer><!-- I 0..* Reference(Practitioner) 
     Who is responsible for the observation --></performer>
 <-- value[x] sliced by type:$this  in the specified orderOpen-->
 <valueQuantity><!-- I 0..1 Quantity Vital Sign Value recorded with UCUM (preferred)   --></valueQuantity>
 <dataAbsentReason><!-- I 0..1 CodeableConcept Why the result value is missing   --></dataAbsentReason>
 <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
 <note><!-- I 0..* Annotation Comments about the observation --></note>
 <bodySite><!-- I 0..1 CodeableConcept Observed body part   --></bodySite>
 <bodyStructure><!-- I 0..1 Reference(BodyStructure) Observed body structure --></bodyStructure>
 <method><!-- I 0..1 CodeableConcept How it was done   --></method>
 <specimen><!-- I 0..1 Reference(Specimen) Specimen used for this observation --></specimen>
 <device><!-- I 0..1 Reference(Device) 
     A reference to the device that generates the measurements or the device settings for the device --></device>
 <referenceRange> I 0..* BackboneElement  <!-- I 0..* Provides guide for interpretation -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <low><!-- I 0..1 Quantity 
      Low Range, if relevant --></low>
  <high><!-- I 0..1 Quantity 
      High Range, if relevant --></high>
  <normalValue><!-- I 0..1 CodeableConcept Normal value, if relevant   --></normalValue>
  <type><!-- I 0..1 CodeableConcept Reference range qualifier   --></type>
  <appliesTo><!-- I 0..* CodeableConcept Reference range population   --></appliesTo>
  <age><!-- I 0..1 Range 
      Applicable age range, if relevant --></age>
  <text value="[markdown]"/><!-- I 0..1 Text based reference range in an observation -->
 </referenceRange>
 <hasMember><!-- I 0..* Reference(QuestionnaireResponse) 
     Used when reporting vital signs panel components --></hasMember>
 <derivedFrom><!-- I 0..* Reference(DocumentReference) 
     Related resource from which the observation is made --></derivedFrom>
 <component> I 0..* BackboneElement  <!-- I 0..* Used when reporting systolic and diastolic blood pressure. -->
  <modifierExtension><!-- I 0..* Extension  Extensions that cannot be ignored even if unrecognized  --></modifierExtension>
  <code><!-- I 1..1 CodeableConcept Type of component observation (code / type)   --></code>
  <-- value[x] sliced by type:$this  in the specified orderOpen-->
  <valueQuantity><!-- I 0..1 Quantity Vital Sign Component Value recorded with UCUM (preferred)   --></valueQuantity>
  <dataAbsentReason><!-- I 0..1 CodeableConcept Why the component result value is missing   --></dataAbsentReason>
  <interpretation><!-- I 0..* CodeableConcept High, low, normal, etc   --></interpretation>
  <referenceRange><!-- See http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange  Provides guide for interpretation of component result value --></referenceRange>
 </component>
</Observation>

JSON Template

{ // Observationvitalsignsbase
  // from Element: extension
    "meta" : { Meta }, // IMetadata about the resource
    "implicitRules" : "<uri>", // IA set of rules under which this content was created
    "language" : "<code>", // ILanguage of the resource content
    "text" : { Narrative }, // IText summary of the resource, for human interpretation
    "contained" : [{ Resource }], //Contained, inline Resources
    "modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored
    "identifier" : [{ Identifier }], // IBusiness Identifier for observation
  // value[x]: Instantiates FHIR ObservationDefinition. One of these 2:
    "instantiatesCanonical" : "<canonical>", // IInstantiates FHIR ObservationDefinition
    "instantiatesReference" : { Reference(ObservationDefinition) }, // IInstantiates FHIR ObservationDefinition
    "basedOn" : [{ Reference(CarePlan) }], // IFulfills plan, proposal or order
    "triggeredBy" : [{ BackboneElement }], // ITriggering observation(s)
    "partOf" : [{ Reference(MedicationAdministration) }], // IPart of referenced event
    "status" : "<code>", // I R! registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
    "category" : [ //  sliced by pattern:$this  in the specified order, Open 
      { // Classification of  type of observation // I R! 
        // from Element: extension
      }
    ],
    "code" : { CodeableConcept }, // I R! Vital Sign Measurement
    "subject" : { Reference(Patient) }, // I R! Who and/or what the observation is about
    "focus" : [{ Reference(Resource) }], // IWhat the observation is about, when it is not about the subject of record
    "encounter" : { Reference(Encounter) }, // IHealthcare event during which this observation is made
  // value[x]: Often just a dateTime for Vital Signs. One of these 2:
    "effectiveDateTime" : "<dateTime>", // I R! Often just a dateTime for Vital Signs
    "effectivePeriod" : { Period }, // I R! Often just a dateTime for Vital Signs
    "issued" : "<instant>", // IDate/Time this version was made available
    "performer" : [{ Reference(Practitioner) }], // IWho is responsible for the observation
    "valueQuantity" : [ //  sliced by type:$this  in the specified order, Open 
      { // Vital Sign Value recorded with UCUM (preferred) // I
        // from Element: extension
      }
    ],
    "dataAbsentReason" : { CodeableConcept }, // IWhy the result value is missing
    "interpretation" : [{ CodeableConcept }], // IHigh, low, normal, etc
    "note" : [{ Annotation }], // IComments about the observation
    "bodySite" : { CodeableConcept }, // IObserved body part
    "bodyStructure" : { Reference(BodyStructure) }, // IObserved body structure
    "method" : { CodeableConcept }, // IHow it was done
    "specimen" : { Reference(Specimen) }, // ISpecimen used for this observation
    "device" : { Reference(Device) }, // IA reference to the device that generates the measurements or the device settings for the device
    "referenceRange" : [{ BackboneElement }], // IProvides guide for interpretation
    "hasMember" : [{ Reference(QuestionnaireResponse) }], // IUsed when reporting vital signs panel components
    "derivedFrom" : [{ Reference(DocumentReference) }], // IRelated resource from which the observation is made
    "component" : [{ BackboneElement }], // IUsed when reporting systolic and diastolic blood pressure.
  }

 

Alternate definitions: Master Definition (XML, JSON), Schematron

10.1.18.2.4 Terminology Bindings

Path Name Conformance ValueSet
Observation.language All Languages required All Languages
Observation.triggeredBy.type triggered Bytype required triggered Bytype
Observation.status Observation Status required Observation Status
Observation.category Observation Category Codes preferred Observation Category Codes
Observation.category Observation Category Codes preferred Observation Category Codes
Observation.code Vital Signs Measurement preferred Vital Signs Measurement
Observation.value[x] Vital Signs Units preferred Vital Signs Units
Observation.dataAbsentReason Data Absent Reason extensible Data Absent Reason
Observation.interpretation Observation Interpretation Codes extensible Observation Interpretation Codes
Observation.bodySite SNOMED CT Body Structures example SNOMED CT Body Structures
Observation.method Observation Methods example Observation Methods
Observation.referenceRange.normalValue Observation Reference Range Normal Value Codes extensible Observation Reference Range Normal Value Codes
Observation.referenceRange.type Observation Reference Range Meaning Codes preferred Observation Reference Range Meaning Codes
Observation.referenceRange.appliesTo Observation Reference Range Applies To Codes example Observation Reference Range Applies To Codes
Observation.component.code Vital Signs Component Measurement preferred Vital Signs Component Measurement
Observation.component.value[x] Vital Signs Units preferred Vital Signs Units
Observation.component.dataAbsentReason Data Absent Reason extensible Data Absent Reason
Observation.component.interpretation Observation Interpretation Codes extensible Observation Interpretation Codes

10.1.18.2.5 Constraints

RuleRuleRule
Id Path Details Requirements
vs-2 Observation If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
Expression icon: (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-1 Observation.effective[x] if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
Expression icon: ($this as dateTime).toString().length() >= 8
vs-3 Observation.component If there is no a value a data absent reason must be present
Expression icon: value.exists() or dataAbsentReason.exists()
. .