For Observations derived from SDOH screening surveys/questionnaires.

Used for simple observations such as education status, food insecurity observations, etc.
This profile allows the representation of SDOH observations based on SDOH screening questionnaire responses (which can also be represented using SDC QuestionnaireResponse).

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

The status of the observation value.

Further constrained to values that are relevant for SDOH.

To identify that an SDOH observation screening response is derived from an SDOH questionnaire, the “social-history” and “survey” codes are required.

Used for filtering social history observations.

Used for filtering observations derived from a survey/questionnaire.

An SDOH category assigned to the observation.

Codes for high-level SDOH categories.

Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to an observation. It is recommended that SDOH category codes be used to facilitate searching for SDOH observations.

Codes identifying names of simple observations.

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
Inadequate Housing Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

Knowing what kind of observation is being made is essential to understanding the observation.

The Gravity implemenation guide restricts questionnaire/survey observations to LOINC to move the industry to the use of LOINC panels/surveys (structures that are not available in other terminology systems) to standardize the coding of SDOH related risk assessment instruments. In addition, USCDI and US Core have standardized on the use of LOINC to represent Observations in general.

Cardinality is 1..1.

The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time".

At least a date should be present unless this observation is a historical report.

Some questions on an SDOH screening questionnaire are not answered directly (e.g., asserted) by the individual completing the questionnaire. Rather, the answer to some questions (e.g., the Hunger Vital Sign 88124-3 “Food insecurity risk”) may be derived from answers to one or more other questions. For an Observation Screening Response that is derived, as opposed to answered directly, Observation.performer should not be specified.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if a reason for its omission is captured by Observation.dataAbsentReason.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if it a reason for its omission is captured by Observation.dataAbsentReason.

This is the entire UCUM code set.

The allowed set of codes will 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.

This value set includes all LOINC codes

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For a given LOINC question, if the LOINC answer list includes concepts such as 'unknown' or 'not available', they should be used for Observation.value. Where these concepts are not part of the value set for Observation.value, the Observation.dataAbsentReason can be used if necessary and appropriate.

References the child observations of a grouping observation.

This is the set of child observations that are expected to be supported by SDOH implementations.

Other types of observations or resources can still be sent, but SDOH systems aren't required to pay attention to them.

Provides context to the child observations of "in what instrument/panel was this information collected", which is critical in situations where the child observations do not have derivedFrom relationships to a QuestionnaireResponse.

The target resource represents a QuestionnaireResponse or other Observation from which the value of this Observation was inferred or calculated.

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 types of 'derivedFrom' resources that must be supported by implementations conforming to this IG

Additional derivation targets (as supported by the underlying Observation resource) are allowed, but there is no expectation that implementers of this IG will pay attention to them.

Allows traceability (and context) for Observations derived from a QuestionnaireResponse and also establishes links for observations that were calculated or inferred based on other Observations (e.g. for calculated scores).

For Observations derived from SDOH screening surveys/questionnaires.

Used for simple observations such as education status, food insecurity observations, etc.
This profile allows the representation of SDOH observations based on SDOH screening questionnaire responses (which can also be represented using SDC QuestionnaireResponse).

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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.

The status of the observation value.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Further constrained to values that are relevant for SDOH.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

To identify that an SDOH observation screening response is derived from an SDOH questionnaire, the “social-history” and “survey” codes are required.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

Used for filtering social history observations.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

Used for filtering observations derived from a survey/questionnaire.

An SDOH category assigned to the observation.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high-level SDOH categories.

Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to an observation. It is recommended that SDOH category codes be used to facilitate searching for SDOH observations.

Describes what was observed. Sometimes this is called the observation "name".

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Codes identifying names of simple observations.

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
Inadequate Housing Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

Knowing what kind of observation is being made is essential to understanding the observation.

The Gravity implemenation guide restricts questionnaire/survey observations to LOINC to move the industry to the use of LOINC panels/surveys (structures that are not available in other terminology systems) to standardize the coding of SDOH related risk assessment instruments. In addition, USCDI and US Core have standardized on the use of LOINC to represent Observations in general.

The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

Cardinality is 1..1.

Observations have no value if you don't know who or what they're about.

The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time".

At least a date should be present unless this observation is a historical report.

Knowing when an observation was deemed true is important to its relevance as well as determining trends.

Who was responsible for asserting the observed value as "true".

Some questions on an SDOH screening questionnaire are not answered directly (e.g., asserted) by the individual completing the questionnaire. Rather, the answer to some questions (e.g., the Hunger Vital Sign 88124-3 “Food insecurity risk”) may be derived from answers to one or more other questions. For an Observation Screening Response that is derived, as opposed to answered directly, Observation.performer should not be specified.

The information determined as a result of making the observation, if the information has a simple value.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if a reason for its omission is captured by Observation.dataAbsentReason.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if it a reason for its omission is captured by Observation.dataAbsentReason.

The information determined as a result of making the observation, if the information has a simple value.

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 below.

This is the entire UCUM code set.

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

The information determined as a result of making the observation, if the information has a simple value.

The allowed set of codes will 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.

This value set includes all LOINC codes

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Provides a reason why the expected value in the element Observation.value[x] is missing.

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For a given LOINC question, if the LOINC answer list includes concepts such as 'unknown' or 'not available', they should be used for Observation.value. Where these concepts are not part of the value set for Observation.value, the Observation.dataAbsentReason can be used if necessary and appropriate.

Codes specifying why the result (Observation.value[x]) is missing.

For many results it is necessary to handle exceptional values in measurements.

Indicates the site on the subject's body where the observation was made (i.e. the target site).

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.

Codes describing anatomical locations. May include laterality.

The specimen that was used when this observation was made.

Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

References the child observations of a grouping observation.

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 below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

This is the set of child observations that are expected to be supported by SDOH implementations.

Other types of observations or resources can still be sent, but SDOH systems aren't required to pay attention to them.

Provides context to the child observations of "in what instrument/panel was this information collected", which is critical in situations where the child observations do not have derivedFrom relationships to a QuestionnaireResponse.

The target resource represents a QuestionnaireResponse or other Observation from which the value of this Observation was inferred or calculated.

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 types of 'derivedFrom' resources that must be supported by implementations conforming to this IG

Additional derivation targets (as supported by the underlying Observation resource) are allowed, but there is no expectation that implementers of this IG will pay attention to them.

Allows traceability (and context) for Observations derived from a QuestionnaireResponse and also establishes links for observations that were calculated or inferred based on other Observations (e.g. for calculated scores).

For Observations derived from SDOH screening surveys/questionnaires.

Used for simple observations such as education status, food insecurity observations, etc.
This profile allows the representation of SDOH observations based on SDOH screening questionnaire responses (which can also be represented using SDC QuestionnaireResponse).

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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.

A unique identifier assigned to this observation.

Allows observations to be distinguished and referenced.

A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

The status of the observation value.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Further constrained to values that are relevant for SDOH.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

To identify that an SDOH observation screening response is derived from an SDOH questionnaire, the “social-history” and “survey” codes are required.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

Used for filtering social history observations.

A code that classifies the general type of observation being made.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high level observation categories.

Used for filtering observations derived from a survey/questionnaire.

An SDOH category assigned to the observation.

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Codes for high-level SDOH categories.

Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to an observation. It is recommended that SDOH category codes be used to facilitate searching for SDOH observations.

Describes what was observed. Sometimes this is called the observation "name".

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Codes identifying names of simple observations.

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
Inadequate Housing Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments And Questions	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Required	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

Knowing what kind of observation is being made is essential to understanding the observation.

The Gravity implemenation guide restricts questionnaire/survey observations to LOINC to move the industry to the use of LOINC panels/surveys (structures that are not available in other terminology systems) to standardize the coding of SDOH related risk assessment instruments. In addition, USCDI and US Core have standardized on the use of LOINC to represent Observations in general.

The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

Cardinality is 1..1.

Observations have no value if you don't know who or what they're about.

The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

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.

The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

For some observations it may be important to know the link between an observation and a particular encounter.

The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time".

At least a date should be present unless this observation is a historical report.

Knowing when an observation was deemed true is important to its relevance as well as determining trends.

The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.

For Observations that don’t require review and verification, it may be the same as the 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.

Who was responsible for asserting the observed value as "true".

Some questions on an SDOH screening questionnaire are not answered directly (e.g., asserted) by the individual completing the questionnaire. Rather, the answer to some questions (e.g., the Hunger Vital Sign 88124-3 “Food insecurity risk”) may be derived from answers to one or more other questions. For an Observation Screening Response that is derived, as opposed to answered directly, Observation.performer should not be specified.

The information determined as a result of making the observation, if the information has a simple value.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if a reason for its omission is captured by Observation.dataAbsentReason.

An observation exists to have a value, though it might not if it is in error, if it represents a group of observations, or if it a reason for its omission is captured by Observation.dataAbsentReason.

The information determined as a result of making the observation, if the information has a simple value.

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 below.

This is the entire UCUM code set.

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

The information determined as a result of making the observation, if the information has a simple value.

The allowed set of codes will 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.

This value set includes all LOINC codes

Additional Bindings	Purpose	Usage
Digital Access Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-access
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): digital-literacy
Less Than High School Education Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): educational-attainment
Elder Abuse Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): elder-abuse
Unemployment Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): employment-status
Financial Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): financial-insecurity
Food Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): food-insecurity
Health Insurance Coverage Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): health-insurance-coverage-status
Homelessness Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): homelessness
Housing Instability Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): housing-instability
VSAC 2.16.840.1.113762.1.4.1196.178	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): inadequate-housing
Intimate Partner Violence Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): intimate-partner-violence
Material Hardship Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): material-hardship
Medical Cost Burden Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): medical-cost-burden
Health Literacy Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): personal-health-literacy
Social Connection Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): social-connection
Stress Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): stress
Transportation Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): transportation-insecurity
Utility Insecurity Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): utility-insecurity
Veteran Status Screening Assessments Answers	Extensible	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): veteran-status
LOINCCodes	Preferred	Observation.category (Details: SDOHCC-ObservationScreeningResponse code Observation.category = ' Observation.category ', stated as ' null '): sdoh-category-unspecified

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Provides a reason why the expected value in the element Observation.value[x] is missing.

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For a given LOINC question, if the LOINC answer list includes concepts such as 'unknown' or 'not available', they should be used for Observation.value. Where these concepts are not part of the value set for Observation.value, the Observation.dataAbsentReason can be used if necessary and appropriate.

Codes specifying why the result (Observation.value[x]) is missing.

For many results it is necessary to handle exceptional values in measurements.

A categorical assessment of an observation value. For example, high, low, normal.

Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

Codes identifying interpretations of observations.

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments about the observation or the results.

May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

Need to be able to provide free text additional information.

Indicates the site on the subject's body where the observation was made (i.e. the target site).

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.

Codes describing anatomical locations. May include laterality.

Indicates the mechanism used to perform the observation.

Only used if not implicit in code for Observation.code.

Methods for simple observations.

In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

The specimen that was used when this observation was made.

Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

The device used to generate the observation data.

Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. 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.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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.

The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

Code for the meaning of a reference range.

Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

Codes identifying the population the reference range applies to.

Need to be able to identify the target population for proper interpretation.

The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

Some analytes vary greatly over age.

Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".

References the child observations of a grouping observation.

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 below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

This is the set of child observations that are expected to be supported by SDOH implementations.

Other types of observations or resources can still be sent, but SDOH systems aren't required to pay attention to them.

Provides context to the child observations of "in what instrument/panel was this information collected", which is critical in situations where the child observations do not have derivedFrom relationships to a QuestionnaireResponse.

The target resource represents a QuestionnaireResponse or other Observation from which the value of this Observation was inferred or calculated.

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 types of 'derivedFrom' resources that must be supported by implementations conforming to this IG

Additional derivation targets (as supported by the underlying Observation resource) are allowed, but there is no expectation that implementers of this IG will pay attention to them.

Allows traceability (and context) for Observations derived from a QuestionnaireResponse and also establishes links for observations that were calculated or inferred based on other Observations (e.g. for calculated scores).

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.

For a discussion on the ways Observations can be assembled in groups together see Notes below.

Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. 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.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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.

Describes what was observed. Sometimes this is called the observation "code".

All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Codes identifying names of simple observations.

Knowing what kind of observation is being made is essential to understanding the observation.

The information determined as a result of making the observation, if the information has a simple value.

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 below.

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Provides a reason why the expected value in the element Observation.component.value[x] is missing.

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

Codes specifying why the result (Observation.value[x]) is missing.

For many results it is necessary to handle exceptional values in measurements.

A categorical assessment of an observation value. For example, high, low, normal.

Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

Codes identifying interpretations of observations.

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Guidance on how to interpret the value by comparison to a normal or recommended range.

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.