CA Baseline Observation (Laboratory Results) Profile

This Observation (Laboratory Results) profile further constrains the Observation (General Use) profile to represent results of laboratory tests.

This profile may represent a single value from a specific laboratory test (e.g. hematocrit) or it may represent a grouped set of results from a multi- test study or panel (e.g. complete blood count, urinalysis, electrolytes).

The Observation (Laboratory Results) profile reflects localization concepts in the Canadian context. 

Mandatory Data Elements

All elements or attributes within the FHIR specification have cardinality as part of their definition - a minimum number of required appearances and a maximum number of allowable appearances.

Most elements in the FHIR specification have a minimum cardinality of 0, so most elements are not required and subsequently they may be missing from a resource when it is exchanged between systems.

Required elements:

• status of the result value
• category to classify the general type of observation being made
• category: laboratory (mandatory child element of above)
• code to classify what was observed
• reference to a subject

Note: if Observation.component is provided then Observation.component.value is mandatory.

Must Support Data Elements

Some elements are marked as Must Support. This means that implementations generating, receiving, or otherwise using resources with Must Support elements SHALL provide support for those elements in some meaningful way (see Must Support definition).

The following elements are marked as Must Support in the Observation (Laboratory Results) profile:

Must Support elements:

• category
• category:laboratory
• code
• reference to a subject
• effective date
• performer
• value
• component.code (if implementer supports component)
• component.value[x] (if implementer supports component)

Data Absent Reason

If the minimum cardinality of an element or attribute is 1 AND information is missing AND the Responder knows the precise reason for the absence of data, then Responders SHOULD send the reason for the missing information using values from the valueset where it exists by using the DataAbsentReason extension.

An Observation without a value, SHOULD include a reason why the data is absent unless there are component observations, or references to other Observations that are grouped within it, i.e., unless there are component observations, or references to other Observations that are grouped within it then either ONE of Observation.value OR Observation.dataAbsentReason but NOT both should be present.

Note: The conformance language above was modified from SHALL to SHOULD to reflect the community decision to relax the invariant to account for Canadian implementations that have reason to not meet the rule given circumstances with R4 modeling for value expressions that is corrected in later versions of FHIR. At least one Canadian lab implementation uses an extension to communicate a result value in the form of a PDF (which R4 does not support under its existing value data types).

Usage Note

Observation (Laboratory Results) is intended to represent results of laboratory tests and studies. This profile constrains the Observation (General Use) resource to represent laboratory results in messages and patient summaries if no other, more specific profile is more appropriate.

The following list of examples is intended to represent some examples of typical use cases and is not exhaustive:

• complete blood count
• prothrombin time
• basic metabolic panel
• comprehensive metabolic panel
• lipid panel
• liver panel
• thyroid stimulating hormone
• hemoglobin a1c
• culture and sensitivity

including the interpretations and reference ranges associated with the result(s).

Observation (Laboratory Results) should not be used if one of the following profiles is applicable: (to be completed later)

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from ObservationProfile

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	ObservationProfile	Observation Profile
status		1..1	code	registered | preliminary | final | amended +
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	S	1..1	Reference(Patient Profile | Group | Device | Location)	Who and/or what the observation is about
effective[x]	SC	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued		0..1	instant	Date/Time this version was made available
performer	S	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueCodeableConcept	C	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	FHIR standard classification of type of observation code system
code		1..1	code	A code difining laboratory result
value[x]:valueQuantity		0..1	Quantity	Actual result
value		1..1	decimal	Numerical value (with implicit precision)
system	C	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason		0..1	CodeableConcept	Why the result is missing
interpretation		0..*	CodeableConcept	High, low, normal, etc.
referenceRange		0..*	BackboneElement	Provides guide for interpretation
hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
component		0..*	BackboneElement	Component results
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result Slice: Unordered, Open by type:$this
value[x]:valueCodeableConcept	C	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding		0..*	Coding	FHIR standard classification of type of observation code system
system		1..1	uri	FHIR standard classification of type of observation code system
code		1..1	code	A code defining laboratory result
value[x]:valueQuantity		0..1	Quantity	Actual component result
value		1..1	decimal	Numerical value (with implicit precision)
system	C	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason		0..1	CodeableConcept	Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	ObservationProfile	Observation Profile obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	SΣ	1..1	Reference(Patient Profile | Group | Device | Location)	Who and/or what the observation is about
effective[x]	SΣC	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding	Σ	0..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
code	Σ	1..1	code	A code difining laboratory result
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
component	Σ	0..*	BackboneElement	Component results
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	SΣ	0..1		Actual component result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding	Σ	0..*	Coding	FHIR standard classification of type of observation code system
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
code	Σ	1..1	code	A code defining laboratory result
value[x]:valueQuantity	SΣ	0..1	Quantity	Actual component result
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:laboratory	preferred	Pattern: laboratory http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	ObservationProfile	Observation Profile obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT 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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' 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: laboratory
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	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	SΣ	1..1	Reference(Patient Profile | Group | Device | Location)	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	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	A code difining laboratory result
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	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	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
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	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	SΣ	0..1		Actual component result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	FHIR standard classification of type of observation code system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	A code defining laboratory result
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value[x]:valueQuantity	SΣ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:laboratory	preferred	Pattern: laboratory http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Differential View

This structure is derived from ObservationProfile

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	ObservationProfile	Observation Profile
status		1..1	code	registered | preliminary | final | amended +
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	S	1..1	Reference(Patient Profile | Group | Device | Location)	Who and/or what the observation is about
effective[x]	SC	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued		0..1	instant	Date/Time this version was made available
performer	S	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueCodeableConcept	C	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	FHIR standard classification of type of observation code system
code		1..1	code	A code difining laboratory result
value[x]:valueQuantity		0..1	Quantity	Actual result
value		1..1	decimal	Numerical value (with implicit precision)
system	C	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason		0..1	CodeableConcept	Why the result is missing
interpretation		0..*	CodeableConcept	High, low, normal, etc.
referenceRange		0..*	BackboneElement	Provides guide for interpretation
hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
component		0..*	BackboneElement	Component results
code	S	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result Slice: Unordered, Open by type:$this
value[x]:valueCodeableConcept	C	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding		0..*	Coding	FHIR standard classification of type of observation code system
system		1..1	uri	FHIR standard classification of type of observation code system
code		1..1	code	A code defining laboratory result
value[x]:valueQuantity		0..1	Quantity	Actual component result
value		1..1	decimal	Numerical value (with implicit precision)
system	C	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason		0..1	CodeableConcept	Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	ObservationProfile	Observation Profile obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: laboratory
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	SΣ	1..1	Reference(Patient Profile | Group | Device | Location)	Who and/or what the observation is about
effective[x]	SΣC	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding	Σ	0..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
code	Σ	1..1	code	A code difining laboratory result
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
component	Σ	0..*	BackboneElement	Component results
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	SΣ	0..1		Actual component result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
coding	Σ	0..*	Coding	FHIR standard classification of type of observation code system
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
code	Σ	1..1	code	A code defining laboratory result
value[x]:valueQuantity	SΣ	0..1	Quantity	Actual component result
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:laboratory	preferred	Pattern: laboratory http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	ObservationProfile	Observation Profile obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT 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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!Σ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:laboratory	SC	1..*	CodeableConcept	FHIR standard classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. ca-baseline-category: SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' 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: laboratory
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	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
subject	SΣ	1..1	Reference(Patient Profile | Group | Device | Location)	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	0..1		Clinically relevant time/time-period for observation ca-baseline-datetime: Datetime SHALL be at least to day
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	A code difining laboratory result
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	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	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
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	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (preferred): LOINC codes identifying names of simple observations.
Slices for value[x]	SΣ	0..1		Actual component result 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
value[x]:valueCodeableConcept	SΣC	0..1	CodeableConcept	Actual component result ca-baseline-results-1: SHOULD use SNOMED CT for coded Results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	FHIR standard classification of type of observation code system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	FHIR standard classification of type of observation code system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	A code defining laboratory result
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value[x]:valueQuantity	SΣ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form ca-baseline-results-2: SHALL use UCUM for coded quantity units Fixed Value: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:laboratory	preferred	Pattern: laboratory http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-category	error	Observation.category:laboratory	SHALL have a category from 'http://terminology.hl7.org/CodeSystem/observation-category' : where(coding.system='http://terminology.hl7.org/CodeSystem/observation-category' and coding.code.exists()).exists()
ca-baseline-datetime	error	Observation.effective[x]	Datetime SHALL be at least to day : ($this as dateTime).toString().length() >= 8
ca-baseline-results-1	warning	Observation.value[x]:valueCodeableConcept, Observation.component.value[x]:valueCodeableConcept	SHOULD use SNOMED CT for coded Results : valueCodeableConcept.coding.system.empty() or valueCodeableConcept.coding.system = 'http://snomed.info/sct'
ca-baseline-results-2	error	Observation.value[x]:valueQuantity.system, Observation.component.value[x]:valueQuantity.system	SHALL use UCUM for coded quantity units : where(valueQuantity.system='http://unitsofmeasure.org' and valueQuantity.value.exists()).exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from ObservationProfile