PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0 - STU 2 – Ballot United States of America flag

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. 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/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

Resource Profile: ADI Documentation Observation

Official URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation Version: 2.0.0
Standards status: Trial-use Computable Name: ADIDocumentationObservation
Other Identifiers: OID:2.16.840.1.113883.4.642.40.68.42.7

This profile is used to indicate if additional advance directive documents, such as physician order for life sustaining treatment (MOLST or POLST) or Do Not Resuscitate Order (DNR) exist and a reference to the document.

The ADI Document observation represents the existence of any advance directive documents the patient may want to notify the treating care team of, so as to further support personalized care delivery. The observation is not intended to communicate the actual contents of those additional documents, if they exist, but are intended to represent that the documents exist so that further investigation can be undertaken to locate them or learn more about them. Duplicate form completion, inconsistent form responses, and siloed documents are a source of misinformation and confusion during care delivery so this section is intended to create awareness that other forms of advance healthcare decisions exist that the person wants others to be aware of in an effort to potentially locate the documents so as to reduce confusion and misinformation.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
Observation.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Observation.text This element must be supported. 1..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
Observation.Slices for extension Content/Rules for all slices
Observation.Slices for extension.extension:supporting-info This element must be supported. 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
Observation.Slices for extension.extension:supporting-info.extension 0..0 Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info.url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
Observation.Slices for extension.extension:supporting-info.value[x] This element must be supported. 1..1 Reference(US Core ADI DocumentReference Profile This type must be supported. | Resource) Reference to patient or provider authored ADI documents
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Observation.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final (extensions allowed)
Observation.Slices for category This element must be supported. 0..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core This element must be supported. 0..1 CodeableConcept Classification of type of observation
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
      "code" : "observation-adi-documentation"
    }
  ]
}
Observation.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "45473-6"
    }
  ]
}
Observation.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
Observation.focus This element is included in summaries. 0..* Reference(Resource) Reference to the additional document this observation is about
Observation.effective[x] This element must be supported. This element is included in summaries. 1..1 Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime dateTime
Observation.effective[x].effectivePeriod Period
Observation.effective[x].effectiveTiming Timing
Observation.effective[x].effectiveInstant instant
Observation.issued This element must be supported. This element is included in summaries. 0..1 instant Date/Time this observation was made available
Observation.performer This element must be supported. This element is included in summaries. 1..1 Reference(US Core Practitioner Profile This type must be supported. | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
Observation.value[x] This element must be supported. This element is included in summaries. C 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns (required): Answer Set with Yes No and Unknowns
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.derivedFrom This element is included in summaries. 0..* Reference(ADI Document Reference) Reference to the additional document that exists

doco 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 US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.value[x] Base required Answer Set with Yes No and Unknowns ⏿20241005 tx.fhir.org

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()
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()

This structure is derived from USCoreObservationADIDocumentationProfile

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-data-absent-reason-required
Observation.text This element must be supported. 1..1 Narrative Text summary of the resource, for human interpretation
Observation.Slices for extension Content/Rules for all slices
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.status 1..1 code registered | preliminary | final | amended +
Required Pattern: final (extensions allowed)
Observation.effective[x] This element must be supported. 1..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for observation
Observation.performer 1..1 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
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.derivedFrom 0..* Reference(ADI Document Reference) Reference to the additional document that exists

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
Observation.id This element is included in summaries. 0..1 id Logical id of this artifact
Observation.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Observation.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Observation.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Observation.text This element must be supported. 1..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
Observation.contained 0..* Resource Contained, inline Resources
Observation.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info This element must be supported. 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
Observation.Slices for extension.extension:supporting-info.id 0..1 string Unique id for inter-element referencing
Observation.Slices for extension.extension:supporting-info.extension 0..0 Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info.url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
Observation.Slices for extension.extension:supporting-info.value[x] This element must be supported. 1..1 Reference(US Core ADI DocumentReference Profile This type must be supported. | Resource) Reference to patient or provider authored ADI documents
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Observation.identifier This element is included in summaries. 0..* Identifier Business Identifier for observation
Observation.basedOn This element is included in summaries. 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
Observation.partOf This element is included in summaries. 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
Observation.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final (extensions allowed)
Observation.Slices for category This element must be supported. 0..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core This element must be supported. 0..1 CodeableConcept Classification of type of observation
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
      "code" : "observation-adi-documentation"
    }
  ]
}
Observation.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "45473-6"
    }
  ]
}
Observation.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
Observation.focus This element is included in summaries. 0..* Reference(Resource) Reference to the additional document this observation is about
Observation.encounter This element is included in summaries. 0..1 Reference(Encounter) Healthcare event during which this observation is made
Observation.effective[x] This element must be supported. This element is included in summaries. 1..1 Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime dateTime
Observation.effective[x].effectivePeriod Period
Observation.effective[x].effectiveTiming Timing
Observation.effective[x].effectiveInstant instant
Observation.issued This element must be supported. This element is included in summaries. 0..1 instant Date/Time this observation was made available
Observation.performer This element must be supported. This element is included in summaries. 1..1 Reference(US Core Practitioner Profile This type must be supported. | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
Observation.value[x] This element must be supported. This element is included in summaries. C 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns (required): Answer Set with Yes No and Unknowns
Observation.dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Observation.method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
Observation.specimen 0..1 Reference(Specimen) Specimen used for this observation
Observation.device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
Observation.referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
Observation.referenceRange.id 0..1 string Unique id for inter-element referencing
Observation.referenceRange.extension 0..* Extension Additional content defined by implementations
Observation.referenceRange.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
Constraints: sqty-1
Observation.referenceRange.high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
Constraints: sqty-1
Observation.referenceRange.type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age 0..1 Range Applicable age range, if relevant
Observation.referenceRange.text 0..1 string Text based reference range in an observation
Observation.hasMember This element is included in summaries. 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
Observation.derivedFrom This element is included in summaries. 0..* Reference(ADI Document Reference) Reference to the additional document that exists
Observation.component This element is included in summaries. 0..* BackboneElement Component results
Observation.component.id 0..1 string Unique id for inter-element referencing
Observation.component.extension 0..* Extension Additional content defined by implementations
Observation.component.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Observation.component.code This element is included in summaries. 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Observation.component.value[x] This element is included in summaries. 0..1 Actual component result
Observation.component.value[x].valueQuantity Quantity
Observation.component.value[x].valueCodeableConcept CodeableConcept
Observation.component.value[x].valueString string
Observation.component.value[x].valueBoolean boolean
Observation.component.value[x].valueInteger integer
Observation.component.value[x].valueRange Range
Observation.component.value[x].valueRatio Ratio
Observation.component.value[x].valueSampledData SampledData
Observation.component.value[x].valueTime time
Observation.component.value[x].valueDateTime dateTime
Observation.component.value[x].valuePeriod Period
Observation.component.dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.component.interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.component.referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco 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 US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.value[x] Base required Answer Set with Yes No and Unknowns ⏿20241005 tx.fhir.org
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 example LOINC Codes 📍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()
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()
sqty-1 error Observation.referenceRange.low, Observation.referenceRange.high The comparator is not used on a SimpleQuantity comparator.empty()

This structure is derived from USCoreObservationADIDocumentationProfile

Summary

Mandatory: 3 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
Observation.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Observation.text This element must be supported. 1..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
Observation.Slices for extension Content/Rules for all slices
Observation.Slices for extension.extension:supporting-info This element must be supported. 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
Observation.Slices for extension.extension:supporting-info.extension 0..0 Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info.url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
Observation.Slices for extension.extension:supporting-info.value[x] This element must be supported. 1..1 Reference(US Core ADI DocumentReference Profile This type must be supported. | Resource) Reference to patient or provider authored ADI documents
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Observation.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final (extensions allowed)
Observation.Slices for category This element must be supported. 0..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core This element must be supported. 0..1 CodeableConcept Classification of type of observation
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
      "code" : "observation-adi-documentation"
    }
  ]
}
Observation.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "45473-6"
    }
  ]
}
Observation.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
Observation.focus This element is included in summaries. 0..* Reference(Resource) Reference to the additional document this observation is about
Observation.effective[x] This element must be supported. This element is included in summaries. 1..1 Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime dateTime
Observation.effective[x].effectivePeriod Period
Observation.effective[x].effectiveTiming Timing
Observation.effective[x].effectiveInstant instant
Observation.issued This element must be supported. This element is included in summaries. 0..1 instant Date/Time this observation was made available
Observation.performer This element must be supported. This element is included in summaries. 1..1 Reference(US Core Practitioner Profile This type must be supported. | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
Observation.value[x] This element must be supported. This element is included in summaries. C 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns (required): Answer Set with Yes No and Unknowns
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.derivedFrom This element is included in summaries. 0..* Reference(ADI Document Reference) Reference to the additional document that exists

doco 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 US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.value[x] Base required Answer Set with Yes No and Unknowns ⏿20241005 tx.fhir.org

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()
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()

Differential View

This structure is derived from USCoreObservationADIDocumentationProfile

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-data-absent-reason-required
Observation.text This element must be supported. 1..1 Narrative Text summary of the resource, for human interpretation
Observation.Slices for extension Content/Rules for all slices
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.status 1..1 code registered | preliminary | final | amended +
Required Pattern: final (extensions allowed)
Observation.focus 0..* Reference(Resource) Reference to the additional document this observation is about
Observation.effective[x] This element must be supported. 1..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for observation
Observation.performer 1..1 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
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.derivedFrom 0..* Reference(ADI Document Reference) Reference to the additional document that exists

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
Observation.id This element is included in summaries. 0..1 id Logical id of this artifact
Observation.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Observation.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Observation.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Observation.text This element must be supported. 1..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
Observation.contained 0..* Resource Contained, inline Resources
Observation.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info This element must be supported. 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
Observation.Slices for extension.extension:supporting-info.id 0..1 string Unique id for inter-element referencing
Observation.Slices for extension.extension:supporting-info.extension 0..0 Extension
Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:supporting-info.url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
Observation.Slices for extension.extension:supporting-info.value[x] This element must be supported. 1..1 Reference(US Core ADI DocumentReference Profile This type must be supported. | Resource) Reference to patient or provider authored ADI documents
Observation.Slices for extension.extension:ADIDocumentationAbsentReason This element must be supported. 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
Observation.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Observation.identifier This element is included in summaries. 0..* Identifier Business Identifier for observation
Observation.basedOn This element is included in summaries. 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
Observation.partOf This element is included in summaries. 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
Observation.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final (extensions allowed)
Observation.Slices for category This element must be supported. 0..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:$this
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Observation.Slices for category.category:us-core This element must be supported. 0..1 CodeableConcept Classification of type of observation
Binding: US Core Simple Observation Category (preferred): FHIR and US Core codes for high level observation categories.

Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
      "code" : "observation-adi-documentation"
    }
  ]
}
Observation.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: 
{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "45473-6"
    }
  ]
}
Observation.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
Observation.focus This element is included in summaries. 0..* Reference(Resource) Reference to the additional document this observation is about
Observation.encounter This element is included in summaries. 0..1 Reference(Encounter) Healthcare event during which this observation is made
Observation.effective[x] This element must be supported. This element is included in summaries. 1..1 Clinically relevant time/time-period for observation
Observation.effective[x].effectiveDateTime dateTime
Observation.effective[x].effectivePeriod Period
Observation.effective[x].effectiveTiming Timing
Observation.effective[x].effectiveInstant instant
Observation.issued This element must be supported. This element is included in summaries. 0..1 instant Date/Time this observation was made available
Observation.performer This element must be supported. This element is included in summaries. 1..1 Reference(US Core Practitioner Profile This type must be supported. | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
Observation.value[x] This element must be supported. This element is included in summaries. C 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns (required): Answer Set with Yes No and Unknowns
Observation.dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.note This element must be supported. 0..* Annotation Comments about the observation
Observation.bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Observation.method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
Observation.specimen 0..1 Reference(Specimen) Specimen used for this observation
Observation.device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
Observation.referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
Observation.referenceRange.id 0..1 string Unique id for inter-element referencing
Observation.referenceRange.extension 0..* Extension Additional content defined by implementations
Observation.referenceRange.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
Constraints: sqty-1
Observation.referenceRange.high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
Constraints: sqty-1
Observation.referenceRange.type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age 0..1 Range Applicable age range, if relevant
Observation.referenceRange.text 0..1 string Text based reference range in an observation
Observation.hasMember This element is included in summaries. 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
Observation.derivedFrom This element is included in summaries. 0..* Reference(ADI Document Reference) Reference to the additional document that exists
Observation.component This element is included in summaries. 0..* BackboneElement Component results
Observation.component.id 0..1 string Unique id for inter-element referencing
Observation.component.extension 0..* Extension Additional content defined by implementations
Observation.component.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Observation.component.code This element is included in summaries. 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Observation.component.value[x] This element is included in summaries. 0..1 Actual component result
Observation.component.value[x].valueQuantity Quantity
Observation.component.value[x].valueCodeableConcept CodeableConcept
Observation.component.value[x].valueString string
Observation.component.value[x].valueBoolean boolean
Observation.component.value[x].valueInteger integer
Observation.component.value[x].valueRange Range
Observation.component.value[x].valueRatio Ratio
Observation.component.value[x].valueSampledData SampledData
Observation.component.value[x].valueTime time
Observation.component.value[x].valueDateTime dateTime
Observation.component.value[x].valuePeriod Period
Observation.component.dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.component.interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.component.referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco 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 US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.category:us-core Base preferred US Core Simple Observation Category 📦9.0.0 US Core v9.0
Observation.code Base example LOINC Codes 📍4.0.1 FHIR Std.
Observation.value[x] Base required Answer Set with Yes No and Unknowns ⏿20241005 tx.fhir.org
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 example LOINC Codes 📍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()
obs-data-absent-reason-required error Observation The ADI Documentation Absent Reason extension SHALL be present when Observation.valueCodeableConcept contains SNOMED CT code 373067005. value.coding.where(system = 'http://snomed.info/sct' and code = '373067005').exists() implies extension.where(url = 'http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason').exists()
sqty-1 error Observation.referenceRange.low, Observation.referenceRange.high The comparator is not used on a SimpleQuantity comparator.empty()

This structure is derived from USCoreObservationADIDocumentationProfile

Summary

Mandatory: 3 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron