Vital Signs with Qualifying Elements
2.0.0 - ci-build International flag

Vital Signs with Qualifying Elements, published by HL7 International - Clinical Information Modeling Initiative. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cimi-vital-signs/ and changes regularly. See the Directory of published versions

Resource Profile: Body Temperature

Official URL: http://hl7.org/fhir/us/vitals/StructureDefinition/body-temperature Version: 2.0.0
Draft as of 2024-10-09 Computable Name: BodyTemperature

Copyright/Legal: Logica Health, all rights reserved Creative Commons License

The measured heat of an individual's body.

Scope

The Body Temperature profile contains one observation, temperature. In addition, this profile contains the following qualifying observations with associated SNOMED CT value sets: observation-deviceCode and MeasurementSetting.

Examples

The following examples are provided to illustrate conformant resource content to this profile.

Use Cases

1. Rectal temperature.

FHIR path and element binding Text Description Code Terminology
Observation.code Temperature 8310-5 LOINC
Observation.bodySite.value Rectum structure (body structure) 34402009 SNOMED CT

Value sets:

Value Set Purpose
Body Temperature Measurement Device value set Body temperature is taken, and the user records measurement method or instrument used to evaluate the temperature. It combines method and device values because they often overlap in EHR documentation systems.
Body Temperature Measurement Body Location value set SELECT SNOMED CT code system values that describe where on the body the temperature was measured.

Usage:

Formal Views of Profile Content

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

This structure is derived from observation-bodytemp

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..* observation-bodytemp FHIR Body Temperature Profile
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... value[x] 0..1 CodeableConcept Value of extension
..... Slices for value[x] Content/Rules for all slices
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... code 1..1 CodeableConcept Body temperature
... Slices for value[x] Content/Rules for all slices
.... value[x]:valueQuantity 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... code 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-bodytemp FHIR Body Temperature 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
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/observation-deviceCode"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt"
..... Slices for value[x] 0..1 CodeableConcept Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... 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 SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ 1..1 CodeableConcept Body temperature
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:BodyTempCode Σ 1..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8310-5
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... value SΣ 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 SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... dataAbsentReason SC 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: Numeric Result Interpretation value set (extensible)
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-bodytemp FHIR Body Temperature 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
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/observation-deviceCode"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt"
..... Slices for value[x] 0..1 CodeableConcept Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... 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 ?!SΣ 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 SΣ 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 SΣ 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 SΣ 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 SΣ 1..1 CodeableConcept Body temperature
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:BodyTempCode Σ 1..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 Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8310-5
...... 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
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... 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 SΣ 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 SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... dataAbsentReason SC 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: Numeric Result Interpretation value set (extensible)
... note 0..* Annotation Comments about the observation
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)
... 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(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 SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

Differential View

This structure is derived from observation-bodytemp

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..* observation-bodytemp FHIR Body Temperature Profile
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... value[x] 0..1 CodeableConcept Value of extension
..... Slices for value[x] Content/Rules for all slices
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... code 1..1 CodeableConcept Body temperature
... Slices for value[x] Content/Rules for all slices
.... value[x]:valueQuantity 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... code 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-bodytemp FHIR Body Temperature 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
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/observation-deviceCode"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt"
..... Slices for value[x] 0..1 CodeableConcept Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... 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 SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ 1..1 CodeableConcept Body temperature
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:BodyTempCode Σ 1..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8310-5
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... value SΣ 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 SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... dataAbsentReason SC 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: Numeric Result Interpretation value set (extensible)
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)
... component SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* observation-bodytemp FHIR Body Temperature 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
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... measurmentDevice S 0..1 (Complex) Measurement Device Type
URL: http://hl7.org/fhir/StructureDefinition/observation-deviceCode
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/observation-deviceCode"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: Body Temperature Measurement Device value set (extensible)
.... MeasurementSetting S 0..1 CodeableConcept Measurement setting
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/MeasurementSettingExt
Binding: Measurement Setting value set (extensible)
.... associatedSituation S 0..1 (Complex) Associated situation
URL: http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/us/vitals/StructureDefinition/AssociatedSituationExt"
..... Slices for value[x] 0..1 CodeableConcept Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension
Binding: Body Temperature Associated Situation value set (example)
... 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 ?!SΣ 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 SΣ 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 SΣ 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 SΣ 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 SΣ 1..1 CodeableConcept Body temperature
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 0..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
..... coding:BodyTempCode Σ 1..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 Σ 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 8310-5
...... 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
... subject SΣ 1..1 Reference(Patient) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣC 1..1 Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
Slice: Unordered, Closed by type:$this
.... value[x]:valueQuantity SΣC 0..1 Quantity Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... 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 SΣ 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 SΣ 1..1 string Unit representation
..... system SΣC 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣ 1..1 code Coded responses from the common UCUM units for vital signs value set.
Binding: Temperature Units of Measure value set (required)
... dataAbsentReason SC 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: Numeric Result Interpretation value set (extensible)
... note 0..* Annotation Comments about the observation
... bodySite S 0..1 CodeableConcept Observed body part
Binding: Body Temperature Measurement Body Location value set (extensible)
... 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(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 SΣC 0..* BackboneElement Used when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: VitalSigns (extensible): This identifies the vital sign result type.

.... value[x] SΣC 0..1 Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason SC 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.extension:measurmentDevice.value[x]extensibleBodyTemperatureMeasurementDevicevalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasurementDeviceVS
from this IG
Observation.extension:associatedSituation.value[x]:valueCodeableConceptexampleBodyTempAssociatedSituationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/BodyTempAssociatedSituationVS
from this IG
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.value[x]:valueQuantity.coderequiredTemperatureUOMVS
http://hl7.org/fhir/us/vitals/ValueSet/TemperatureUOMVS
from this IG
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleNumericResultInterpretationNom
http://hl7.org/fhir/us/vitals/ValueSet/NumericResultIntVS
from this IG
Observation.bodySiteextensibleBodyTemperatureMeasurementBodyLocationvalueset
http://hl7.org/fhir/us/vitals/ValueSet/bodyTempMeasBodyLocationPrecoordVS
from this IG
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeextensibleVitalSigns
http://hl7.org/fhir/ValueSet/observation-vitalsignresult
from the FHIR Standard
Observation.component.value[x]extensibleVitalSignsUnits
http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

 

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