# US Core Observation Occupation Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Observation Occupation Profile**

## Resource Profile: US Core Observation Occupation Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 3 | *Computable Name*:USCoreObservationOccupationProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.44 | | |

 
The US Core Observation Occupation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) **Occupation** and **Occupation Industry** Data Elements. It sets minimum expectations for the Observation resource to record, search, and fetch a patient's past or present job as occupation and industry, in other words, the type of work and type of business that compensates for work or assigns work to an unpaid worker or volunteer. In the context of this profile, a job is defined as a work situation or a training or volunteer position held for a specified period. This profile specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for this profile:

* Query for a patient's work history
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) past or present jobs belonging to a patient

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each Observation Must Have:**

1. a status
1. a code for job history
1. a patient
1. the job code or text

**Each Observation Must Support:**

1. a category code of "social-history"
1. when the job occurred
1. a code for the job history industry
1. the industry code or text

**Additional USCDI Requirements:**

These [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the Observation examples.

1. a performer1

1 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* A code system value **SHOULD** be supplied for each additional code.[§](requirements.md#CONF-0420)
* For the current job, systems **SHALL** omit `observation.effectivePeriod.end` to indicate it is ongoing.[§](requirements.md#CONF-0432)
* When the industry is known, but the occupation is not, systems **SHALL** use the value "unknown" from the [DataAbsentReason Code System](http://hl7.org/fhir/R4/codesystem-data-absent-reason.html).[§](requirements.md#CONF-0433) However, when the occupation is known but the industry is not, systems **SHALL** omit the industry `Observation.component`.[§](requirements.md#CONF-0434) The guide provides examples for both scenarios.
* In the [Quick Start](#notes) section below, you can find instructions on searching for Occupations (Jobs) by `patient`, `date`, and other core search parameters. Refer to the FHIR [search](http://hl7.org/fhir/search.html) specification for more advanced queries using Observation.
* Refer to the [Occupational Data for Health (ODH)](http://hl7.org/fhir/us/odh/index.html) FHIR IG to convey additional details; data elements, such as Employer; or different topics, such as Usual (Longest-Held) Work.

* 1The profile elements `Observation.performer and Observation.device` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Examples for this Profile: [Observation/observation-occupation-industry-unknown](Observation-observation-occupation-industry-unknown.md), [Observation/observation-occupation-unknown](Observation-observation-occupation-unknown.md) and [Observation/observation-occupation](Observation-observation-occupation.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.core|current/StructureDefinition/us-core-observation-occupation)

**Changes since version 8.0.1:**

* The resource metadata has changed (description, copyright)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-observation-occupation.csv), [Excel](StructureDefinition-us-core-observation-occupation.xlsx), [Schematron](StructureDefinition-us-core-observation-occupation.sch) 

### Notes:

-------

**Quick Start**  

-------

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to social history data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/Observation.rs` [§](requirements.md#CONF-0145)
* [granular scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#finer-grained-resource-constraints-using-search-parameters): `<patient|user|system>/Observation.rs?category=http://terminology.hl7.org//CodeSystem-observation-category|social-history` [§](requirements.md#CONF-0162)

-------

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations **SHALL** be supported:

1. **SHALL** support searching for all Observations using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) search parameters`GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and a category code = "social-history" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by code using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [code](SearchParameter-us-core-observation-code.md) search parameters
* Including optional support **OR** search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
`GET [base]/Observation?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|11341-5

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The US Core Observation Occupation Profile "code" parameter searches only `.code` and not `component.code`. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by date (for example, results after 2018) using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [date](SearchParameter-us-core-observation-date.md) search parameters
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&date=ge2018-03-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and date and a category code = "social-history" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).

#### Optional Search Parameters:

The following search parameters and search parameter combinations **SHOULD** be supported

1. **SHOULD** support searching for all Observations for a patient for a given status (for example all observations marked as final) using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [status](SearchParameter-us-core-observation-status.md) search parameters
* Including support **OR** search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
`GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&status={system|}[search_code]{,{system|}[code],...}`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&status=final

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and category = "social-history" and status ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [_lastUpdated](SearchParameter-us-core-observation-lastupdated.md) search parameters
* Including optional support for **AND** search on `_lastUpdated` (e.g.`_lastUpdated=[date]&_lastUpdated=[date]&...`)
* Including support for these `_lastUpdated` comparators: "gt", "lt", "ge", "le"
`GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&_lastUpdated=[dateTime]`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&_lastUpdated=ge2024-01-01T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and category code = "social-history" and _lastUpdated. See the US Core General Guidance page for [Searching Using lastUpdated](general-guidance.md#searching-using-lastupdated). ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).
1. **SHOULD** support searching Observations by code and date using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [code](SearchParameter-us-core-observation-code.md) and [date](SearchParameter-us-core-observation-date.md) search parameters
* Including optional support **OR** search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/Observation?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Example:
> 
1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|11341-5&date=ge2019-01-01T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Occupation Profile resources for the specified patient and date and code(s). SHOULD support search by multiple codes. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-observation-occupation",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 3
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.44"
  }],
  "version" : "9.0.0",
  "name" : "USCoreObservationOccupationProfile",
  "title" : "US Core Observation Occupation Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core Observation Occupation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI)  *Occupation* and *Occupation Industry* Data Elements. It sets minimum expectations for the Observation resource to record, search, and fetch a patient's past or present job as occupation and industry, in other words, the type of work and type of business that compensates for work or assigns work to an unpaid worker or volunteer. In the context of this profile, a job is defined as a work situation or a training or volunteer position held for a specified period. This profile specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "sct-concept",
    "uri" : "http://snomed.info/conceptdomain",
    "name" : "SNOMED CT Concept Domain Binding"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "sct-attr",
    "uri" : "http://snomed.org/attributebinding",
    "name" : "SNOMED CT Attribute Binding"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Observation",
      "path" : "Observation",
      "short" : "Past Or Present Occupation",
      "definition" : "Related data elements for a current or previous job.",
      "comment" : "A person can have more than one job at the same time and multiple jobs over time",
      "mustSupport" : false
    },
    {
      "id" : "Observation.status",
      "path" : "Observation.status",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category",
      "path" : "Observation.category",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "$this"
        }],
        "rules" : "open"
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.category:socialhistory",
      "path" : "Observation.category",
      "sliceName" : "socialhistory",
      "min" : 0,
      "max" : "1",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
          "code" : "social-history"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.code",
      "path" : "Observation.code",
      "short" : "Occupation history",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "11341-5"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.subject",
      "path" : "Observation.subject",
      "min" : 1,
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.effectivePeriod",
      "path" : "Observation.effectivePeriod",
      "mustSupport" : true
    },
    {
      "id" : "Observation.performer",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Observation.performer",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }]
    },
    {
      "id" : "Observation.valueCodeableConcept",
      "path" : "Observation.valueCodeableConcept",
      "short" : "Coded occupation or text",
      "comment" : "Express the occupation type using a coded value. If no coded value is available, use text. If the occupation is not available, the reason should be communicated in `Observation.dataAbsentReason`.",
      "min" : 1,
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "Occupational Data for Health",
        "valueSet" : "http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7901"
      }
    },
    {
      "id" : "Observation.component",
      "path" : "Observation.component",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "code"
        }],
        "rules" : "open"
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.component:industry",
      "path" : "Observation.component",
      "sliceName" : "industry",
      "short" : "Occupation industry",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.component:industry.code",
      "path" : "Observation.component.code",
      "short" : "Occupation industry history",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "86188-0"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.component:industry.valueCodeableConcept",
      "path" : "Observation.component.valueCodeableConcept",
      "short" : "Occupation industry or text",
      "comment" : "Express the occupation industry type using a coded value. If no coded value is available, use text. If the occupation industry is not available, the reason should be communicated `Observation.component.dataAbsentReason`",
      "min" : 1,
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "Occupational Data for Health",
        "valueSet" : "http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7900"
      }
    }]
  }
}

```
