PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - 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-ballot 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-ballot
Standards status: Trial-use Maturity Level: 2 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: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 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
... Slices for extension Content/Rules for all slices
.... extension:supporting-info S 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
..... value[x] S 1..1 Reference(US Core ADI DocumentReference Profile S | Resource) Reference to patient or provider authored ADI documents
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final
... Slices for category S 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.
.... category:us-core S 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: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: observation-adi-documentation
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 45473-6
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) Reference to the additional document this observation is about
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued SΣ 0..1 instant Date/Time this observation was made available
... performer SΣ 1..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
... value[x] SΣC 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns . (required): Answer Set with Yes No and Unknowns
... note S 0..* Annotation Comments about the observation
... derivedFrom Σ 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 VSAC v0.24

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: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-data-absent-reason-required
... text S 1..1 Narrative Text summary of the resource, for human interpretation
... Slices for extension Content/Rules for all slices
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... status 1..1 code registered | preliminary | final | amended +
Required Pattern: final
... effective[x] S 1..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for 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
... note S 0..* Annotation Comments about the 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: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
... 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 S 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
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:supporting-info S 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
..... value[x] S 1..1 Reference(US Core ADI DocumentReference Profile S | Resource) Reference to patient or provider authored ADI documents
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... 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): Codes providing the status of an observation.
Required Pattern: final
... Slices for category S 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.
.... category:us-core S 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: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: observation-adi-documentation
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 45473-6
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) Reference to the additional document this observation is about
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued SΣ 0..1 instant Date/Time this observation was made available
... performer SΣ 1..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
... value[x] SΣC 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns . (required): Answer Set with Yes No and Unknowns
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note S 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(ADI Document Reference) Reference to the additional document that exists
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

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 VSAC v0.24
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()

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:

Maturity: 2

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 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
... Slices for extension Content/Rules for all slices
.... extension:supporting-info S 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
..... value[x] S 1..1 Reference(US Core ADI DocumentReference Profile S | Resource) Reference to patient or provider authored ADI documents
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.
Required Pattern: final
... Slices for category S 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.
.... category:us-core S 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: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: observation-adi-documentation
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 45473-6
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) Reference to the additional document this observation is about
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued SΣ 0..1 instant Date/Time this observation was made available
... performer SΣ 1..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
... value[x] SΣC 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns . (required): Answer Set with Yes No and Unknowns
... note S 0..* Annotation Comments about the observation
... derivedFrom Σ 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 VSAC v0.24

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: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-data-absent-reason-required
... text S 1..1 Narrative Text summary of the resource, for human interpretation
... Slices for extension Content/Rules for all slices
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... status 1..1 code registered | preliminary | final | amended +
Required Pattern: final
... effective[x] S 1..1 dateTime, Period, Timing, instant Clinically relevant time/time-period for 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
... note S 0..* Annotation Comments about the 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: Filtersdoco
.. Observation C 0..* USCoreObservationADIDocumentationProfile US Core Observation ADI Presence Profile
Constraints: obs-6, obs-7, obs-data-absent-reason-required
... 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 S 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
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:supporting-info S 0..* (Complex) Relevant ADI documents and information
URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
..... value[x] S 1..1 Reference(US Core ADI DocumentReference Profile S | Resource) Reference to patient or provider authored ADI documents
.... extension:ADIDocumentationAbsentReason S 0..1 CodeableConcept Advance Directive Absent Reason
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-documentation-absent-reason
Binding: DataAbsentReason (required)
... 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): Codes providing the status of an observation.
Required Pattern: final
... Slices for category S 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.
.... category:us-core S 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: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: observation-adi-documentation
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Observation ADI Documentation code
Binding: LOINCCodes (example): Codes identifying names of simple observations.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 45473-6
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) Reference to the additional document this observation is about
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
.... effectiveTiming Timing
.... effectiveInstant instant
... issued SΣ 0..1 instant Date/Time this observation was made available
... performer SΣ 1..1 Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) Who is responsible for the observation
... value[x] SΣC 0..1 CodeableConcept Actual result
Binding: Answer Set with Yes No and Unknowns . (required): Answer Set with Yes No and Unknowns
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note S 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(ADI Document Reference) Reference to the additional document that exists
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

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 VSAC v0.24
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()

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:

Maturity: 2

 

Other representations of profile: CSV, Excel, Schematron