| Left: | US Core Vital Signs Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs) |
| Right: | PACIO Cognitive Status Collection (http://hl7.org/fhir/us/pacio-cs/StructureDefinition/pacio-csc) |
| Error | StructureDefinition.url | Values for url differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs' vs 'http://hl7.org/fhir/us/pacio-cs/StructureDefinition/pacio-csc' |
| Error | StructureDefinition.version | Values for version differ: '7.0.0' vs '1.0.0' |
| Information | StructureDefinition.name | Values for name differ: 'USCoreVitalSignsProfile' vs 'CognitiveStatusCollection' |
| Information | StructureDefinition.title | Values for title differ: 'US Core Vital Signs Profile' vs 'PACIO Cognitive Status Collection' |
| Information | StructureDefinition.date | Values for date differ: '2023-10-17' vs '2024-11-05T07:56:05+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International / Cross-Group Projects' vs 'HL7 Patient Care Work Group' |
| Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/StructureDefinition/vitalsigns' vs 'http://hl7.org/fhir/StructureDefinition/Observation' |
| Information | StructureDefinition.short | Values for short differ: 'US Core Vital Signs Profile' vs 'Measurements and simple assertions' |
| Information | StructureDefinition.definition | Values for definition differ: 'The FHIR Vitals Signs profile sets minimum expectations for the Observation Resource to record, search and fetch the vital signs associated with a patient.' vs 'Measurements and simple assertions made about a patient, device or other subject.' |
| Information | StructureDefinition.short | Values for short differ: 'Additional content defined by implementations' vs 'Extension' |
| Information | StructureDefinition.definition | Values for definition differ: 'May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.' vs 'An Extension' |
| Information | StructureDefinition.requirements | Values for requirements differ: 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/extensibility.html#modifierExtension).' vs 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).' |
| Information | StructureDefinition.short | Values for short differ: 'Fulfills plan, proposal or order' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.short | Values for short differ: 'Part of referenced event' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.comment | Values for comment differ: 'To link an Observation to an Encounter use `encounter`. See the [Notes](http://hl7.org/fhir/observation.html#obsgrouping) below for guidance on referencing another Observation.' vs 'To link an Observation to an Encounter use `encounter`. See the [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below for guidance on referencing another Observation.' |
| Information | StructureDefinition.short | Values for short differ: 'registered | preliminary | final | amended +' vs 'Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used.' |
| Warning | Observation.status | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'Classification of type of observation' vs 'A second category code may be used along with the code “functioning”. For example, for assessment tool/survey instrument observations use “survey” as a second code.' |
| Warning | Observation.category | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'Coded vital sign result type' vs 'For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment.' |
| Information | StructureDefinition.definition | Values for definition differ: 'Coded Responses from C-CDA Vital Sign Results.' vs 'Describes what was observed. Sometimes this is called the observation 'name'.' |
| Information | StructureDefinition.requirements | Values for requirements differ: '5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).' vs 'Knowing what kind of observation is being made is essential to understanding the observation.' |
| Warning | Observation.code | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Error | Observation.code | Unable to resolve left value set http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.62 at Observation.code |
| Information | StructureDefinition.short | Values for short differ: 'Who and/or what the observation is about' vs 'Should only reference a Patient resource.' |
| Warning | Observation.subject | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'What the observation is about, when it is not about the subject of record' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.comment | Values for comment differ: 'Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., 'Blood Glucose') and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](http://hl7.org/fhir/extension-observation-focuscode.html).' vs 'Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., 'Blood Glucose') and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](http://hl7.org/fhir/R4/extension-observation-focuscode.html).' |
| Information | StructureDefinition.short | Values for short differ: 'Often just a dateTime for Vital Signs' vs 'Clinical relevant time for an assessment such as cognitive assessments performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).' |
| Information | StructureDefinition.definition | Values for definition differ: 'Often just a dateTime for Vital Signs.' vs 'Clinical relevant time for an assessment such as cognitive assessments performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime).' |
| Information | StructureDefinition.comment | Values for comment differ: 'At least a date should be present unless this observation is a historical report. For recording imprecise or 'fuzzy' times (For example, a blood glucose measurement taken 'after breakfast') use the [Timing](http://hl7.org/fhir/datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.' vs 'The use of effective[x] and dateTime versus Period is subject to implementer workflow and needs. In most situations, an observation is considered as a point in time, even if the assessment occurred over a period of time. Period is included in this implementation guide to provide additional flexibility for specific use cases. However, it is expected most observations will be recorded using DateTime. Furthermore, any retrieval of information should return the relevant if DateTime is requested, even if the original observation was recorded as a period. Some implementers may choose to use additional functions in there retrieves to 'normalize' intervals, as is done in Clinical Quality Language (CQL).' |
| Warning | Observation.effective[x] | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'Date/Time this version was made available' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.comment | Values for comment differ: 'For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](http://hl7.org/fhir/resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.' vs 'For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](http://hl7.org/fhir/R4/resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.' |
| Information | StructureDefinition.short | Values for short differ: 'Who is responsible for the observation' vs 'The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization.' |
| Information | Observation.performer | Element minimum cardinalities differ: '0' vs '1' |
| Information | StructureDefinition.short | Values for short differ: 'Vital Signs Value' vs 'If used, should use the CodeableConcept datatype whenever possible to provide a suitable code to define the concept for the observation data. When capturing a collection of related observations, typically this field is not used. If the outcome of an assessment includes one or more summary scores, leave this field unused and use the 'hasMember' field to point to one or more Observation resources with each of which has a score provided in the 'value' field.' |
| Information | StructureDefinition.definition | Values for definition differ: 'Vital Signs value are typically recorded using the Quantity data type.' vs 'The information determined as a result of making the observation, if the information has a simple value.' |
| Information | StructureDefinition.comment | Values for comment differ: 'An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/observation.html#notes) below.' vs 'An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/R4/observation.html#notes) below.' |
| Information | StructureDefinition.requirements | Values for requirements differ: '9. SHALL contain exactly one [1..1] value with @xsi:type='PQ' (CONF:7305).' vs 'An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.' |
| Warning | Observation.value[x] | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'Why the result is missing' vs 'Currently not used in CognitiveStatusCollection.' |
| Warning | Observation.dataAbsentReason | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'High, low, normal, etc.' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.short | Values for short differ: 'Observed body part' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.comment | Values for comment differ: 'Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](http://hl7.org/fhir/extension-bodysite.html).' vs 'Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](http://hl7.org/fhir/R4/extension-bodysite.html).' |
| Information | StructureDefinition.short | Values for short differ: 'How it was done' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.short | Values for short differ: 'Specimen used for this observation' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.short | Values for short differ: '(Measurement) Device' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.short | Values for short differ: 'Provides guide for interpretation' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.requirements | Values for requirements differ: 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/extensibility.html#modifierExtension).' vs 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).' |
| Information | StructureDefinition.short | Values for short differ: 'Used when reporting vital signs panel components' vs 'Each cognitive status observation in the collection.' |
| Information | StructureDefinition.definition | Values for definition differ: 'Used when reporting vital signs panel components.' vs 'This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.' |
| Information | StructureDefinition.comment | Values for comment differ: 'When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](http://hl7.org/fhir/questionnaireresponse.html) into a final score and represent the score as an Observation.' vs 'When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](http://hl7.org/fhir/R4/questionnaireresponse.html) into a final score and represent the score as an Observation.' |
| Warning | Observation.hasMember | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Error | Observation.hasMember | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence], CanonicalType[http://hl7.org/fhir/StructureDefinition/vitalsigns]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/pacio-cs/StructureDefinition/pacio-cs]]) |
| Information | StructureDefinition.short | Values for short differ: 'Related measurements the observation is made from' vs 'Should point back to the SDC QuestionnaireResponse that this resource is derived from.' |
| Information | StructureDefinition.comment | Values for comment differ: 'All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/observation.html#obsgrouping) below.' vs 'All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below.' |
| Warning | Observation.derivedFrom | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Error | Observation.derivedFrom | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/DocumentReference], CanonicalType[http://hl7.org/fhir/StructureDefinition/ImagingStudy], CanonicalType[http://hl7.org/fhir/StructureDefinition/Media], CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence], CanonicalType[http://hl7.org/fhir/StructureDefinition/vitalsigns]]) vs Reference([CanonicalType[http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse]]) |
| Information | StructureDefinition.short | Values for short differ: 'Component observations' vs 'Currently not used in CognitiveStatusCollection.' |
| Information | StructureDefinition.definition | Values for definition differ: 'Used when reporting component observation such as systolic and diastolic blood pressure.' vs 'Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.' |
| Information | StructureDefinition.comment | Values for comment differ: 'For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7.org/fhir/observation.html#notes) below.' vs 'For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7.org/fhir/R4/observation.html#notes) below.' |
| Warning | Observation.component | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.requirements | Values for requirements differ: 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/extensibility.html#modifierExtension).' vs 'Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).' |
| Information | StructureDefinition.short | Values for short differ: 'Coded vital sign result type' vs 'Type of component observation (code / type)' |
| Warning | Observation.component.code | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | StructureDefinition.short | Values for short differ: 'Vital Sign Component Value' vs 'Actual component result' |
| Information | StructureDefinition.definition | Values for definition differ: 'Vital Signs value are typically recorded using the Quantity data type. For supporting observations such as cuff size could use other datatypes such as CodeableConcept.' vs 'The information determined as a result of making the observation, if the information has a simple value.' |
| Information | StructureDefinition.comment | Values for comment differ: 'Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/observation.html#notes) below.' vs 'Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](http://hl7.org/fhir/R4/observation.html#notes) below.' |
| Information | StructureDefinition.requirements | Values for requirements differ: '9. SHALL contain exactly one [1..1] value with @xsi:type='PQ' (CONF:7305).' vs 'An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.' |
| Warning | Observation.component.value[x] | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Warning | Observation.component.dataAbsentReason | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Name | Value | Comments | |
|---|---|---|---|
 abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/vitalsigns | http://hl7.org/fhir/StructureDefinition/Observation |
|
| copyright | Used by permission of HL7 International, all rights reserved Creative Commons License |
| |
| date | 2023-10-17 | 2024-11-05T07:56:05+00:00 |
|
| description | This profile is based on the base [FHIR Vital Signs Profile](http://hl7.org/fhir/R4/observation-vitalsigns.html) and defines *additional* constraints on the Observation resource to represent vital signs observations. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. This US Core profiles that are derived from this profile are listed below. | A point in time collection of cognitive status observations for a patient. This profile is used for exchanging a set of observation data collected through the use of a structured resource (e.g. assessment tool, instrument, or screen). |
|
| experimental | false |
| |
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
 jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | USCoreVitalSignsProfile | CognitiveStatusCollection |
|
| publisher | HL7 International / Cross-Group Projects | HL7 Patient Care Work Group |
|
| purpose | |||
| status | active | ||
| title | US Core Vital Signs Profile | PACIO Cognitive Status Collection |
|
| type | Observation | ||
| url | http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs | http://hl7.org/fhir/us/pacio-cs/StructureDefinition/pacio-csc |
|
| version | 7.0.0 | 1.0.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Observation | C | 0..* | observation-vitalsigns | US Core Vital Signs Profile obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | C | 0..* | Observation | Measurements and simple assertions obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | |||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
 extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| identifier | Σ | 0..* | Identifier | Business Identifier for observation | Σ | 0..* | Identifier | Business Identifier for observation | |||||||||
| basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Fulfills plan, proposal or order | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Currently not used in CognitiveStatusCollection. | |||||||||
| partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Part of referenced event | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Currently not used in CognitiveStatusCollection. | |||||||||
| status | ?!SΣ | 1..1 | code | registered | preliminary | final | amended + Binding: ?? (required) | ?!Σ | 1..1 | code | Should have the value 'final' when all the observatons are complete and there are no further actions needed. Otherwise, another value from the value set may appropriately be used. Binding: ?? (required): Codes providing the status of an observation. |
| ||||||||
| Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ?? (preferred): Codes for high level observation categories. | 1..* | CodeableConcept | A second category code may be used along with the code “functioning”. For example, for assessment tool/survey instrument observations use “survey” as a second code. Slice: Unordered, Open by pattern:coding Binding: ?? (preferred): Codes for high level observation categories. |
| |||||||||
| code | SΣ | 1..1 | CodeableConcept | Coded vital sign result type Binding: ?? (extensible): Vital sign result types | Σ | 1..1 | CodeableConcept | For a Post-Acute Care structured assessment resource such as an instrument or screen, use a LOINC code to identify the instrument/screen name or panel/section title to indicate the kind of assessment. Binding: ?? (extensible) |
| ||||||||
| subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about | Σ | 1..1 | Reference(US Core Patient Profile) | Should only reference a Patient resource. |
| ||||||||
| focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record | Σ | 0..* | Reference(Resource) | Currently not used in CognitiveStatusCollection. | |||||||||
| encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made | Σ | 0..1 | Reference(US Core Encounter Profile) | Healthcare event during which this observation is made | |||||||||
| effective[x] | SΣC | 1..1 | dateTime S, Period | Often just a dateTime for Vital Signs vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | Σ | 1..1 | dateTime, Period | Clinical relevant time for an assessment such as cognitive assessments performed with structured evaluation tools is the time the evaluation occurs, i.e., when the clinician obtains the answers entered in the tool. However, the only timing available may be when then tool is completed by the clinician. That timing is generally documented as a point in time (dateTime). |
| ||||||||
| issued | Σ | 0..1 | instant | Date/Time this version was made available | Σ | 0..1 | instant | Currently not used in CognitiveStatusCollection. | |||||||||
| performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) | Who is responsible for the observation | Σ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile) | The person who performed the assessment. The preferred way to specify the performer is to use the PractitionerRole resource to provide both the practitioner and organization. |
| ||||||||
| value[x] | SΣC | 0..1 | Quantity S, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Vital Signs Value Binding: ?? (extensible): Common UCUM units for recording Vital Signs. | ΣC | 0..1 | Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | If used, should use the CodeableConcept datatype whenever possible to provide a suitable code to define the concept for the observation data. When capturing a collection of related observations, typically this field is not used. If the outcome of an assessment includes one or more summary scores, leave this field unused and use the 'hasMember' field to point to one or more Observation resources with each of which has a score provided in the 'value' field. |
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| dataAbsentReason | SC | 0..1 | CodeableConcept | Why the result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing. | C | 0..1 | CodeableConcept | Currently not used in CognitiveStatusCollection. Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing. |
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| interpretation | 0..* | CodeableConcept | High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations. | 0..* | CodeableConcept | Currently not used in CognitiveStatusCollection. Binding: ?? (extensible): Codes identifying interpretations of observations. | |||||||||||
| note | 0..* | Annotation | Comments about the observation | 0..* | Annotation | Comments about the observation | |||||||||||
| bodySite | 0..1 | CodeableConcept | Observed body part Binding: ?? (example): Codes describing anatomical locations. May include laterality. | 0..1 | CodeableConcept | Currently not used in CognitiveStatusCollection. Binding: ?? (example): Codes describing anatomical locations. May include laterality. | |||||||||||
| method | 0..1 | CodeableConcept | How it was done Binding: ?? (example): Methods for simple observations. | 0..1 | CodeableConcept | Currently not used in CognitiveStatusCollection. Binding: ?? (example): Methods for simple observations. | |||||||||||
| specimen | 0..1 | Reference(Specimen) | Specimen used for this observation | 0..1 | Reference(Specimen) | Currently not used in CognitiveStatusCollection. | |||||||||||
| device | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device | 0..1 | Reference(Device | DeviceMetric) | Currently not used in CognitiveStatusCollection. | |||||||||||
 referenceRange | C | 0..* | BackboneElement | Provides guide for interpretation obs-3: Must have at least a low or a high or text | C | 0..* | BackboneElement | Currently not used in CognitiveStatusCollection. obs-3: Must have at least a low or a high or text | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| low | C | 0..1 | ?? | Low Range, if relevant | C | 0..1 | ?? | Low Range, if relevant | |||||||||
| high | C | 0..1 | ?? | High Range, if relevant | C | 0..1 | ?? | High Range, if relevant | |||||||||
| type | 0..1 | CodeableConcept | Reference range qualifier Binding: ?? (preferred): Code for the meaning of a reference range. | 0..1 | CodeableConcept | Reference range qualifier Binding: ?? (preferred): Code for the meaning of a reference range. | |||||||||||
| appliesTo | 0..* | CodeableConcept | Reference range population Binding: ?? (example): Codes identifying the population the reference range applies to. | 0..* | CodeableConcept | Reference range population Binding: ?? (example): Codes identifying the population the reference range applies to. | |||||||||||
| age | 0..1 | Range | Applicable age range, if relevant | 0..1 | Range | Applicable age range, if relevant | |||||||||||
| text | 0..1 | string | Text based reference range in an observation | 0..1 | string | Text based reference range in an observation | |||||||||||
| hasMember | Σ | 0..* | Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Used when reporting vital signs panel components | SΣ | 0..* | Reference(PACIO Cognitive Status) | Each cognitive status observation in the collection. |
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| derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Related measurements the observation is made from | SΣ | 0..* | Reference(SDC Questionnaire Response) | Should point back to the SDC QuestionnaireResponse that this resource is derived from. |
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 component | SΣC | 0..* | BackboneElement | Component observations vs-3: If there is no a value a data absent reason must be present | Σ | 0..* | BackboneElement | Currently not used in CognitiveStatusCollection. |
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 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| code | SΣ | 1..1 | CodeableConcept | Coded vital sign result type Binding: ?? (extensible): Vital sign result types | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: ?? (example): Codes identifying names of simple observations. |
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| value[x] | SΣC | 0..1 | Quantity S, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Vital Sign Component Value Binding: ?? (extensible): Common UCUM units for recording Vital Signs. | Σ | 0..1 | Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Actual component result |
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| dataAbsentReason | SC | 0..1 | CodeableConcept | Why the component result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing. | C | 0..1 | CodeableConcept | Why the component result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing. |
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| interpretation | 0..* | CodeableConcept | High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations. | 0..* | CodeableConcept | High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations. | |||||||||||
 referenceRange | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result | |||||||||||
| Documentation for this format | |||||||||||||||||