SDOH Clinical Care, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-sdoh-clinicalcare/ and changes regularly. See the Directory of published versions

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Resource Profile: SDOHCC Observation Personal Characteristic ( Abstract )

Defines constraints that represent the minimum requirement for personal characteristic observations which are observations that are usually self-attested but may be attested to on behalf of the subject and are generally only verifiable by the source of attestation (e.g., race, ethnicity, sexual orientation, gender identity and personal pronouns), but may sometimes be verifiable by someone other than the source of attestation (e.g., recorded sex). This profile is intended for draft use only. For further details on this profile see Draft Specifications for Personal Characteristics.

Usage:

• Derived from this Resource Profile: SDOHCC Observation Ethnicity OMB, SDOHCC Observation Gender Identity, SDOHCC Observation Personal Pronouns, SDOHCC Observation Race OMB... Show 2 more, SDOHCC Observation Recorded Sex Gender and SDOHCC Observation Sexual Orientation

Formal Views of Profile Content

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

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

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
status	S	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	C	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
effective[x]		0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	S	0..1	CodeableConcept	Actual result
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
derivedFrom	SC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation 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 SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject"
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SΣC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣC	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result
derivedFrom	SΣC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:PersonalCharacteristic	preferred	Pattern: personal-characteristic http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()
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()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation 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 SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject"
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): 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/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
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	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SΣC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣC	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	SΣC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:PersonalCharacteristic	preferred	Pattern: personal-characteristic http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()
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()

This structure is derived from Observation

Summary

Mandatory: 2 elements (1 nested mandatory element)
Must-Support: 8 elements
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the value of value:$this

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
status	S	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	C	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
effective[x]		0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	S	0..1	CodeableConcept	Actual result
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
derivedFrom	SC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation 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 SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject"
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SΣC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣC	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result
derivedFrom	SΣC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:PersonalCharacteristic	preferred	Pattern: personal-characteristic http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	This is an abstract profile. Child profiles: SDOHCCObservationEthnicityOMB, SDOHCCObservationGenderIdentity, SDOHCCObservationPersonalPronouns, SDOHCCObservationRaceOMB, SDOHCCObservationRecordedSexGender, SDOHCCObservationSexualOrientation Personal characteristic observation 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 SDOH-Obs-1: Either subject or extension-Observation.subject must exist but not both SDOH-Obs-2: Focus is only allowed if subject is present SDOH-Obs-3: Must have either performer or derivedFrom
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
OtherSubject	SC	0..1	Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct)	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject"
value[x]		1..1	Reference(US Core Practitioner Profile)	Value of extension
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	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:PersonalCharacteristic	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): 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/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: personal-characteristic
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	Type of observation (code / type) Binding: LOINCCodes (preferred): Codes identifying names of simple observations.
subject	SΣC	0..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣC	0..1	Reference(RelatedPerson)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	Σ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣC	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
value[x]	SΣC	0..1	CodeableConcept	Actual result
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	SΣC	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from
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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Observation.status	required	SDOHCCValueSetObservationStatus http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetObservationStatus from this IG
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.category:PersonalCharacteristic	preferred	Pattern: personal-characteristic http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	preferred	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
SDOH-Obs-1	error	Observation	Either subject or extension-Observation.subject must exist but not both : subject.exists() xor extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject').exists()
SDOH-Obs-2	error	Observation	Focus is only allowed if subject is present : focus.exists() implies subject.exists()
SDOH-Obs-3	error	Observation	Must have either performer or derivedFrom : performer.exists() or derivedFrom.exists()
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()

This structure is derived from Observation

Summary

Mandatory: 2 elements (1 nested mandatory element)
Must-Support: 8 elements
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.subject

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the value of value:$this

Other representations of profile: CSV, Excel, Schematron