US Core Implementation Guide
8.0.1 - STU 8

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Core Pediatric BMI for Age Observation Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age | Version: 8.0.1
Standards status: Trial-use | Maturity Level: 3 | Computable Name: USCorePediatricBMIforAgeObservationProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.2
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Pediatric BMI for Age Observation Profile inherits from the US Core Vital Signs Profile. This profile sets minimum expectations for the Observation resource to record, search, and fetch pediatric body mass index (BMI) percentile per age and sex for youth 2-20 observations in FHIR using a standard LOINC code and UCUM units of measure. It specifies which additional 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 BMI observations belonging to a pediatric patient
- Record or update BMI observations belonging to a pediatric patient

### Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the US Core Vital Signs Profile, the following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.
Note that the "Differential Table" displays elements unique to this profile and the "Key Elements Table” displays a combined view of elements for this profile and the US Core Vital Signs Profile.

Each Observation Must Have:

1. a patient
2. a fixed code for pediatric BMI per age and sex measurement

Each Observation Must Support:

1. a result value

Profile Specific Implementation Guidance:

- - Note that this profile also conforms to the base FHIR Vital Signs Profile.

- The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
  - providing a local system-specific code
  - providing more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.

  A code system value SHOULD be supplied for each additional code.

- The observations MAY have component observations. For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.
- *An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using `Observation.hasMember`.
  - For further guidance, see the Observation Grouping section in FHIR Specification.
  - Systems that never provide an observation without a value are not required to support `Observation.dataAbsentReason`.
- *An `Observation.component` without a value, SHALL include a reason why the data is absent.
  - Systems that never provide a component observation without a component value are not required to support `Observation.component.dataAbsentReason`.

- Implementers may use this profile as a base for other vital signs in addition to those in this guide.

- Information about the growth chart tables used to determine percentiles SHOULD be supplied in `Observation.note.text` (for example, 'CDC Males, 2-20 years Chart').

Usages:

- Examples for this Profile: Observation/pediatric-bmi-example
- CapabilityStatements using this Profile: US Core Client CapabilityStatement and US Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

- No changes

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile Constraints: obs-6, obs-7, vs-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding | S Σ | 1..* | Coding | Code defined by a terminology system
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S Σ | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 Binding: Vital Sign Result Type (extensible): Vital sign result types 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
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
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | Vital Signs Value Slice: Unordered, Open by type:$this Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueQuantity | S Σ C | 0..1 | Quantity S | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
value | S 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 | S Σ | 1..1 | string | Unit representation
system | S Σ C | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S Σ | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S 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 | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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-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()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from USCoreVitalSignsProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile
code | S | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 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://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
valueQuantity | S | 0..1 | Quantity S | Vital Signs Value
value | S | 1..1 | decimal | Numerical value (with implicit precision)
unit | S | 1..1 | string | Unit representation
system | S | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile Constraints: obs-6, obs-7, vs-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
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 | S Σ | 1..* | 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 | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
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
code | S Σ | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 Binding: Vital Sign Result Type (extensible): Vital sign result types 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
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
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | 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] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | Vital Signs Value Slice: Unordered, Open by type:$this Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueQuantity | S Σ C | 0..1 | Quantity S | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
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 | S 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 | S Σ | 1..1 | string | Unit representation
system | S Σ C | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S Σ | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
dataAbsentReason | S 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 Constraints: obs-3
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(4.0.1) | Low Range, if relevant
high | C | 0..1 | SimpleQuantity(4.0.1) | 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(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Used when reporting vital signs panel components
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Related measurements the observation is made from
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
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 | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S 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 | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📍4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 6 elements
Fixed: 2 elements

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile Constraints: obs-6, obs-7, vs-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding | S Σ | 1..* | Coding | Code defined by a terminology system
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S Σ | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 Binding: Vital Sign Result Type (extensible): Vital sign result types 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
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
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | Vital Signs Value Slice: Unordered, Open by type:$this Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueQuantity | S Σ C | 0..1 | Quantity S | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
value | S 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 | S Σ | 1..1 | string | Unit representation
system | S Σ C | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S Σ | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S 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 | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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-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()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

Differential View

This structure is derived from USCoreVitalSignsProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile
code | S | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 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://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
valueQuantity | S | 0..1 | Quantity S | Vital Signs Value
value | S | 1..1 | decimal | Numerical value (with implicit precision)
unit | S | 1..1 | string | Unit representation
system | S | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreVitalSignsProfile | US Core Pediatric BMI for Age Observation Profile Constraints: obs-6, obs-7, vs-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
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 | S Σ | 1..* | 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 | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
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
code | S Σ | 1..1 | CodeableConcept | BMI percentile per age and sex for youth 2-20 Binding: Vital Sign Result Type (extensible): Vital sign result types 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://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 59576-9
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
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | 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] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | Vital Signs Value Slice: Unordered, Open by type:$this Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueQuantity | S Σ C | 0..1 | Quantity S | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
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 | S 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 | S Σ | 1..1 | string | Unit representation
system | S Σ C | 1..1 | uri | System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code | S Σ | 1..1 | code | Coded responses from the common UCUM units for vital signs value set. Fixed Value: %
dataAbsentReason | S 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 Constraints: obs-3
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(4.0.1) | Low Range, if relevant
high | C | 0..1 | SimpleQuantity(4.0.1) | 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(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Used when reporting vital signs panel components
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Related measurements the observation is made from
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
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 | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S 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 | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.value[x]:valueQuantity.​comparator | Base | required | QuantityComparator | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📍4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | 📦20240322 | VSAC v0.24
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 0 element(4 nested mandatory elements)
Must-Support: 6 elements
Fixed: 2 elements

Maturity: 3

Other representations of profile: CSV, Excel, Schematron

### 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 for a complete list of supported RESTful interactions for this IG.

- See the Scopes Format section for a description of the SMART scopes syntax.
- See the Search Syntax section for a description of the US Core search syntax.
- See the General Requirements section for additional rules and expectations when a Server requires status parameters.
- See the General Guidance section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to vital signs data SHALL support these US Core SMART Scopes:

- resource level scopes: `<patient|user|system>/Observation.rs`

- granular scopes: `<patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs`

#### Mandatory Search Parameters:

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

1. SHALL support searching using the combination of the `patient` and `category` search parameters:

   `GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs`

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = `vital-signs` (how to search by reference and how to search by token)

2. SHALL support searching using the combination of the `patient` and `code` search parameters:
   - including optional support for OR search on `code` (e.g.`code={system|}[code],{system|}[code],...`)

   `GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}`

   Example:

   1. GET [base]/Observation?patient=1186747&code=http://loinc.org|29463-7,http://loinc.org|8302-2,http://loinc.org|59576-9

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The Observation `code` parameter searches `Observation.code only. (how to search by reference and how to search by token)

3. SHALL support searching using the combination of the `patient` and `category` and `date` search parameters:
   - including support for these `date` comparators: `gt,lt,ge,le`
   - including optional support for AND search on `date` (e.g.`date=[date]&date=[date]]&...`)

   `GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}`

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = `vital-signs` (how to search by reference and how to search by token and how to search by date)

#### Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the `patient` and `category` and `status` search parameters:
   - including support for OR search on `status` (e.g.`status={system|}[code],{system|}[code],...`)

   `GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status={system|}[code]{,{system|}[code],...}`

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the `patient` and `category` and `_lastUpdated` search parameters:
   - including support for these `_lastUpdated` comparators: `gt,lt,ge,le`
   - including optional support for AND search on `_lastUpdated` (e.g.`_lastUpdated=[date]&_lastUpdated=[date]]&...`)

   `GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}`

   Example:

   1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)

3. SHOULD support searching using the combination of the `patient` and `code` and `date` search parameters:
   - including optional support for OR search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
   - including support for these `date` comparators: `gt,lt,ge,le`
   - including optional support for AND search on `date` (e.g.`date=[date]&date=[date]]&...`)

   `GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}`

   Example:

   1. GET [base]/Observation?patient=1186747&code=http://loinc.org|29463-7,http://loinc.org|8302-2,http://loinc.org|59576-9&date=ge2020-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)