Mandatory Data Elements

The following data elements SHALL or SHALL NOT be present. They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Symptom SHALL Have:

1. a status
2. a category - one repetition must be set to 'symptom'
3. a code which represents the symptom being described
4. a patient
5. a dateTime or period detailing when the symptom occurred
6. a performer of either the Patient or a RelatedPerson who provided the information about the symptom
7. a valueCodeableConcept which indicates whether the symptom was present or was not present

Each Symptom SHALL NOT provide:

1. a data absent reason - if there is no data about the symptom, then just do not provide information about that symptom
2. an interpretation code or a reference range - those apply to observations in general but not to symptom observations
3. a specimen or device - those do not apply to symptom observations

Other Important Data Elements

In a normal profile, we would indicate the remaining data elements using the Must Support flag. But since the expected use of this IG is that other IGs would further constrain the Symptoms profile for their own use, we have intentionally not used the Must Support flag so as not to imply any additionally required conformance statements. Instead, we have indicated data elements that were considered important to convey. These elements are the following:

1. issued - when the symptoms information was recorded. This is different from the effective dateTime or period.
2. bodySite - a code representing where the patient feels the symptom in the body
3. note - a text description of the symptom provided by the patient or caregiver
4. associatedSymptom extension - used to associate other symptoms with this symptom for arbitrary groupings
5. associatedCondition extension - used to indicate a relationship between this symptom and a condition, eg. a symptom known to be due to a patient's condition

Component Observations of the Symptom

A lot of the structured information of the Symptom is profiled in the component observations. These component observations do not have a life of their own but are tied to the symptom itself. Every component observation has a note extension and does not allow a data absent reason, interpretation, or reference range element.

1. Quality - a patient's internal perception of the symptom. This is represented by the LOINC code 56823-8 and a value that is the quality.
2. Severity - the intensity with which the patient experiences the symptom. This is represented by the LOINC code 64750-3 and a value that is the severity.
3. Functional Impact - How the symptom affects the patient's daily activities. This is represented by a code taken from the WHO's International Classification of Functioning, Disability and Health code system. NOTE: This will also allow a variant of PACIO's PFE profile for providing the functional impact.
4. Clinical Course - the character of the symptom onset. This is represented by the LOINC code 89261-2 and a value that is the clinical course. An optional scale code or reference to an assessment scale is provided.
5. Trend - the intensity of the symptom over time. This is represented by the LOINC code 89253-9 and a value that is the trend.
6. Affective Grade - the emotional or mental impact of the symptom. This is represented by the SNOMED code 279116004 (Affective response to pain) and a value that is the affective grade.
7. Triggers or Exacerbating Factors - these are factors which either trigger the symptom or exacerbate the symptom. This is represented by the LOINC code 100752-5 and a value that is the factor. It also provides an extension to indicate a medication that is believed to cause or exacervate the symptom.
8. Alleviating Factors - there are factors that decrease the symptom. This is represented by the LOINC code 100753-3 and a value that is the factor. It also provides an extension to indicate a medication that is believed to alleviate the symptom.
9. Other Events - this is a catch-all to report other events that were occurring at the time of the symptom onset but were not considered triggers. This is represented by the LOINC code 96542-6 and a value that is the event.
10. Frequency - how often the patient experiences the symptom. This is represented by the LOINC code 104156-5 and either a code that represents the frequency or a Ratio to express frequencies such as 2x/day.
11. Speed Of Onset - the rate at which the symptom becomes apparent. This is represented by the LOINC code 99495-4 and a value that is the speed of onset.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
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
extension:associatedSymptom		0..*	(Complex)	Other symptoms associated with this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
value[x]		1..1	Reference(Symptom Observation)	Value of extension
extension:associatedCondition		0..*	(Complex)	Conditions with some relationship to this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
value[x]		1..1	Reference(Condition)	Value of extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75325-1
display		1..1	string	Representation defined by the system Fixed Value: Symptom
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	The patient who is experiencing the symptom
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	1..1	Reference(Patient | RelatedPerson)	The person who is reporting the symptom information
value[x]	SΣC	1..1	CodeableConcept	Coded description of symptom Binding: Common Set of Symptom Codes (preferred) Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
note		0..*	Annotation	Patient or caregiver description of symptom
bodySite	S	0..1	CodeableConcept	Where the patient feels the symptom in the body Binding: SNOMEDCTBodyStructures (preferred)
Slices for component	Σ	0..*	BackboneElement	Various information about the symptom Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
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	1..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
component:quality	Σ	0..1	BackboneElement	The patient's internal perception of the symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom quality URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 56823-8
display		1..1	string	Representation defined by the system Fixed Value: Problem quality or description
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code that represents the symptom quality Binding: LOINC Answer List LL4459-5 (example)
component:severity	Σ	0..1	BackboneElement	The intensity with which the patient experiences the symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom severity URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 64750-3
display		1..1	string	Representation defined by the system Fixed Value: Severity of symptoms
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL1156-0 (example)
component:functionalImpact	Σ	0..*	BackboneElement	How the symptom affects the patient's daily activities
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the impact URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the functional impact being described Binding: Functional Classification Codes (preferred)
value[x]	Σ	1..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
component:clinicalCourse	Σ	0..1	BackboneElement	Character of symptom onset
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the clinical course of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89261-2
display		1..1	string	Representation defined by the system Fixed Value: Clinical course
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4997-4 (example)
component:trend	Σ	0..1	BackboneElement	Intensity of symptom over time
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom trend URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89253-9
display		1..1	string	Representation defined by the system Fixed Value: Trend
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4938-8 (example)
component:affectiveGrade	Σ	0..1	BackboneElement	Emotional or mental impact of a symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the impact of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
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. 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://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 279116004
display		1..1	string	Representation defined by the system Fixed Value: Affective response to pain
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code that represents the affective grade Binding: Affective Grade (example)
component:triggersOrExacerbatingFactors	Σ	0..*	BackboneElement	Patient reported actions, conditions, events, physical objects or other factors that initiate, increase or worsen symptoms
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100752-5
display		1..1	string	Representation defined by the system Fixed Value: Exacerbating factors - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6278-7 (example)
component:alleviatingFactors	Σ	0..*	BackboneElement	Patient-reported actions, conditions, events, or other factors that decrease the symptoms or condition
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100753-3
display		1..1	string	Representation defined by the system Fixed Value: Alleviating factors - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6279-5 (example)
component:otherEvents	Σ	0..*	BackboneElement	Patient-reported actions that were occuring at time of symptom onset
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 96542-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL361-7 (example)
component:frequency	Σ	0..1	BackboneElement	How often the patient experiences the symptom.
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the reported frequency URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 104156-5
display		1..1	string	Representation defined by the system Fixed Value: Condition frequency - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	1..1		Actual component result Slice: Unordered, Closed by type:$this
valueCodeableConcept			CodeableConcept
valueRatio			Ratio
value[x]:valueRatio	Σ	0..1	Ratio	Actual component result
value[x]:valueCodeableConcept	Σ	0..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL6514-5 (preferred)
component:speedOfOnset	Σ	0..1	BackboneElement	The rate at which a physiological symptom became apparent.
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the reported speed of onset URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 99495-4
display		1..1	string	Representation defined by the system Fixed Value: Speed of condition onset
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: Speed of Onset (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.code	example	Pattern Value: LOINC Code 75325-1("Symptom") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]	preferred	CommonSymptomCodes http://hl7.org/fhir/uv/symptoms/ValueSet/CommonSymptomCodes From this IG Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
Observation.bodySite	preferred	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:quality.code	example	Pattern Value: LOINC Code 56823-8("Problem quality or description") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:quality.value[x]	example	LOINC LL4459-5 http://loinc.org/vs/LL4459-5
Observation.component:severity.code	example	Pattern Value: LOINC Code 64750-3("Severity of symptoms") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:severity.value[x]	example	LOINC LL1156-0 http://loinc.org/vs/LL1156-0
Observation.component:functionalImpact.code	preferred	FunctionalClassification http://hl7.org/fhir/uv/symptoms/ValueSet/FunctionalClassification From this IG
Observation.component:clinicalCourse.code	example	Pattern Value: LOINC Code 89261-2("Clinical course") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:clinicalCourse.value[x]	example	LOINC LL4997-4 http://loinc.org/vs/LL4997-4
Observation.component:trend.code	example	Pattern Value: LOINC Code 89253-9("Trend") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:trend.value[x]	example	LOINC LL4938-8 http://loinc.org/vs/LL4938-8
Observation.component:affectiveGrade.code	example	Pattern Value: SNOMED-CT Code 279116004("Affective response to pain") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:affectiveGrade.value[x]	example	AffectiveGrade http://hl7.org/fhir/uv/symptoms/ValueSet/AffectiveGrade From this IG
Observation.component:triggersOrExacerbatingFactors.code	example	Pattern Value: LOINC Code 100752-5("Exacerbating factors - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:triggersOrExacerbatingFactors.value[x]	example	LOINC LL6278-7 http://loinc.org/vs/LL6278-7
Observation.component:alleviatingFactors.code	example	Pattern Value: LOINC Code 100753-3("Alleviating factors - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:alleviatingFactors.value[x]	example	LOINC LL6279-5 http://loinc.org/vs/LL6279-5
Observation.component:otherEvents.code	example	Pattern Value: LOINC Code 96542-6 http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:otherEvents.value[x]	example	LOINC LL361-7 http://loinc.org/vs/LL361-7
Observation.component:frequency.code	example	Pattern Value: LOINC Code 104156-5("Condition frequency - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:frequency.value[x]:valueCodeableConcept	preferred	LOINC LL6514-5 http://loinc.org/vs/LL6514-5
Observation.component:speedOfOnset.code	example	Pattern Value: LOINC Code 99495-4("Speed of condition onset") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:speedOfOnset.value[x]	preferred	SpeedOfOnset http://hl7.org/fhir/uv/symptoms/ValueSet/SpeedOfOnset From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	Observation	Measurements and simple assertions
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:associatedSymptom		0..*	(Complex)	Other symptoms associated with this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
value[x]		1..1	Reference(Symptom Observation)	Value of extension
extension:associatedCondition		0..*	(Complex)	Conditions with some relationship to this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
value[x]		1..1	Reference(Condition)	Value of extension
status	S	1..1	code	registered | preliminary | final | amended +
code	S	1..1	CodeableConcept	Type of observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75325-1
display		1..1	string	Representation defined by the system Fixed Value: Symptom
subject	S	1..1	Reference(Patient)	The patient who is experiencing the symptom
effective[x]	S	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	S	1..1	Reference(Patient | RelatedPerson)	The person who is reporting the symptom information
value[x]	S	1..1	CodeableConcept	Coded description of symptom Binding: Common Set of Symptom Codes (preferred) Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
dataAbsentReason		0..0
interpretation		0..0
note		0..*	Annotation	Patient or caregiver description of symptom
bodySite	S	0..1	CodeableConcept	Where the patient feels the symptom in the body Binding: SNOMEDCTBodyStructures (preferred)
specimen		0..0
device		0..0
referenceRange		0..0
Slices for component		0..*	BackboneElement	Various information about the symptom Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
value[x]		1..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result
dataAbsentReason		0..0
interpretation		0..0
referenceRange		0..0
component:quality		0..1	BackboneElement	The patient's internal perception of the symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom quality URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 56823-8
display		1..1	string	Representation defined by the system Fixed Value: Problem quality or description
value[x]		1..1	CodeableConcept	Code that represents the symptom quality Binding: LOINC Answer List LL4459-5 (example)
component:severity		0..1	BackboneElement	The intensity with which the patient experiences the symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom severity URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 64750-3
display		1..1	string	Representation defined by the system Fixed Value: Severity of symptoms
value[x]		1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL1156-0 (example)
component:functionalImpact		0..*	BackboneElement	How the symptom affects the patient's daily activities
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the impact URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
code		1..1	CodeableConcept	Code for the functional impact being described Binding: Functional Classification Codes (preferred)
component:clinicalCourse		0..1	BackboneElement	Character of symptom onset
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the clinical course of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89261-2
display		1..1	string	Representation defined by the system Fixed Value: Clinical course
value[x]		1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4997-4 (example)
component:trend		0..1	BackboneElement	Intensity of symptom over time
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the symptom trend URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89253-9
display		1..1	string	Representation defined by the system Fixed Value: Trend
value[x]		1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4938-8 (example)
component:affectiveGrade		0..1	BackboneElement	Emotional or mental impact of a symptom
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the impact of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Type of component observation (code / type) 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://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 279116004
display		1..1	string	Representation defined by the system Fixed Value: Affective response to pain
value[x]		1..1	CodeableConcept	Code that represents the affective grade Binding: Affective Grade (example)
component:triggersOrExacerbatingFactors		0..*	BackboneElement	Patient reported actions, conditions, events, physical objects or other factors that initiate, increase or worsen symptoms
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
code		1..1	CodeableConcept	Code for the specific type of event 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100752-5
display		1..1	string	Representation defined by the system Fixed Value: Exacerbating factors - Reported
value[x]		1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6278-7 (example)
component:alleviatingFactors		0..*	BackboneElement	Patient-reported actions, conditions, events, or other factors that decrease the symptoms or condition
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
code		1..1	CodeableConcept	Code for the specific type of event 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100753-3
display		1..1	string	Representation defined by the system Fixed Value: Alleviating factors - Reported
value[x]		1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6279-5 (example)
component:otherEvents		0..*	BackboneElement	Patient-reported actions that were occuring at time of symptom onset
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Code for the specific type of event 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 96542-6
value[x]		1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL361-7 (example)
component:frequency		0..1	BackboneElement	How often the patient experiences the symptom.
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the reported frequency URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 104156-5
display		1..1	string	Representation defined by the system Fixed Value: Condition frequency - Reported
Slices for value[x]		1..1		Actual component result Slice: Unordered, Open by type:$this
valueCodeableConcept			CodeableConcept
valueRatio			Ratio
value[x]:valueRatio		0..1	Ratio	Actual component result
denominator
unit		0..1	string	Unit representation Binding: CommonUCUMCodesForDuration (required)
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL6514-5 (preferred)
component:speedOfOnset		0..1	BackboneElement	The rate at which a physiological symptom became apparent.
Slices for extension				Content/Rules for all slices
extension:text		0..1	Annotation	Textual description of the reported speed of onset URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Type of component observation (code / type) 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 99495-4
display		1..1	string	Representation defined by the system Fixed Value: Speed of condition onset
value[x]		1..1	CodeableConcept	Actual component result Binding: Speed of Onset (preferred)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.value[x]	preferred	CommonSymptomCodes http://hl7.org/fhir/uv/symptoms/ValueSet/CommonSymptomCodes From this IG Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
Observation.bodySite	preferred	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.component:quality.value[x]	example	LOINC LL4459-5 http://loinc.org/vs/LL4459-5
Observation.component:severity.value[x]	example	LOINC LL1156-0 http://loinc.org/vs/LL1156-0
Observation.component:functionalImpact.code	preferred	FunctionalClassification http://hl7.org/fhir/uv/symptoms/ValueSet/FunctionalClassification From this IG
Observation.component:clinicalCourse.value[x]	example	LOINC LL4997-4 http://loinc.org/vs/LL4997-4
Observation.component:trend.value[x]	example	LOINC LL4938-8 http://loinc.org/vs/LL4938-8
Observation.component:affectiveGrade.value[x]	example	AffectiveGrade http://hl7.org/fhir/uv/symptoms/ValueSet/AffectiveGrade From this IG
Observation.component:triggersOrExacerbatingFactors.value[x]	example	LOINC LL6278-7 http://loinc.org/vs/LL6278-7
Observation.component:alleviatingFactors.value[x]	example	LOINC LL6279-5 http://loinc.org/vs/LL6279-5
Observation.component:otherEvents.value[x]	example	LOINC LL361-7 http://loinc.org/vs/LL361-7
Observation.component:frequency.value[x]:valueRatio.denominator.unit	required	CommonUCUMCodesForDuration http://hl7.org/fhir/ValueSet/duration-units From the FHIR Standard
Observation.component:frequency.value[x]:valueCodeableConcept	preferred	LOINC LL6514-5 http://loinc.org/vs/LL6514-5
Observation.component:speedOfOnset.value[x]	preferred	SpeedOfOnset http://hl7.org/fhir/uv/symptoms/ValueSet/SpeedOfOnset From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	Measurements and simple assertions Constraints: obs-6, obs-7
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:associatedSymptom		0..*	(Complex)	Other symptoms associated with this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
value[x]		1..1	Reference(Symptom Observation)	Value of extension
extension:associatedCondition		0..*	(Complex)	Conditions with some relationship to this symptom URL: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo"
value[x]		1..1	Reference(Condition)	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	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75325-1
display		1..1	string	Representation defined by the system Fixed Value: Symptom
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	The patient who is experiencing the symptom
focus	Σ	0..*	Reference(Resource)	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]	SΣ	1..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	SΣ	1..1	Reference(Patient | RelatedPerson)	The person who is reporting the symptom information
value[x]	SΣC	1..1	CodeableConcept	Coded description of symptom Binding: Common Set of Symptom Codes (preferred) Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
note		0..*	Annotation	Patient or caregiver description of symptom
bodySite	S	0..1	CodeableConcept	Where the patient feels the symptom in the body Binding: SNOMEDCTBodyStructures (preferred)
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
Slices for component	Σ	0..*	BackboneElement	Various information about the symptom Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
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	1..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
component:quality	Σ	0..1	BackboneElement	The patient's internal perception of the symptom
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the symptom quality URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 56823-8
display		1..1	string	Representation defined by the system Fixed Value: Problem quality or description
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code that represents the symptom quality Binding: LOINC Answer List LL4459-5 (example)
component:severity	Σ	0..1	BackboneElement	The intensity with which the patient experiences the symptom
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the symptom severity URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 64750-3
display		1..1	string	Representation defined by the system Fixed Value: Severity of symptoms
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL1156-0 (example)
component:functionalImpact	Σ	0..*	BackboneElement	How the symptom affects the patient's daily activities
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the impact URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the functional impact being described Binding: Functional Classification Codes (preferred)
value[x]	Σ	1..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
component:clinicalCourse	Σ	0..1	BackboneElement	Character of symptom onset
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the clinical course of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
extension:scaleCode		0..1	CodeableConcept, Reference(Assessment Scale Observation)	Assessment Scale Information URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/AssessmentScaleInformation
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89261-2
display		1..1	string	Representation defined by the system Fixed Value: Clinical course
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4997-4 (example)
component:trend	Σ	0..1	BackboneElement	Intensity of symptom over time
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the symptom trend URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 89253-9
display		1..1	string	Representation defined by the system Fixed Value: Trend
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL4938-8 (example)
component:affectiveGrade	Σ	0..1	BackboneElement	Emotional or mental impact of a symptom
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the impact of the symptom URL: http://hl7.org/fhir/StructureDefinition/note
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. 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://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 279116004
display		1..1	string	Representation defined by the system Fixed Value: Affective response to pain
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code that represents the affective grade Binding: Affective Grade (example)
component:triggersOrExacerbatingFactors	Σ	0..*	BackboneElement	Patient reported actions, conditions, events, physical objects or other factors that initiate, increase or worsen symptoms
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100752-5
display		1..1	string	Representation defined by the system Fixed Value: Exacerbating factors - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6278-7 (example)
component:alleviatingFactors	Σ	0..*	BackboneElement	Patient-reported actions, conditions, events, or other factors that decrease the symptoms or condition
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
extension:relatedMedication		0..*	Reference(MedicationStatement)	Surrounding Event Medication URL: http://hl7.org/fhir/uv/symptoms/StructureDefinition/SurroundingEventMedication
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 100753-3
display		1..1	string	Representation defined by the system Fixed Value: Alleviating factors - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL6279-5 (example)
component:otherEvents	Σ	0..*	BackboneElement	Patient-reported actions that were occuring at time of symptom onset
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the event URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Code for the specific type of event Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 96542-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Code or string describing the specific event Binding: LOINC Answer List LL361-7 (example)
component:frequency	Σ	0..1	BackboneElement	How often the patient experiences the symptom.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the reported frequency URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 104156-5
display		1..1	string	Representation defined by the system Fixed Value: Condition frequency - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	1..1		Actual component result Slice: Unordered, Closed by type:$this
valueCodeableConcept			CodeableConcept
valueRatio			Ratio
value[x]:valueRatio	Σ	0..1	Ratio	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
numerator	Σ	0..1	Quantity	Numerator value
denominator	Σ	0..1	Quantity	Denominator value
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation Binding: CommonUCUMCodesForDuration (required)
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
value[x]:valueCodeableConcept	Σ	0..1	CodeableConcept	Actual component result Binding: LOINC Answer List LL6514-5 (preferred)
component:speedOfOnset	Σ	0..1	BackboneElement	The rate at which a physiological symptom became apparent.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	Annotation	Textual description of the reported speed of onset URL: http://hl7.org/fhir/StructureDefinition/note
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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 99495-4
display		1..1	string	Representation defined by the system Fixed Value: Speed of condition onset
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value[x]	Σ	1..1	CodeableConcept	Actual component result Binding: Speed of Onset (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|4.0.1 From the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category|4.0.1 From the FHIR Standard
Observation.code	example	Pattern Value: LOINC Code 75325-1("Symptom") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.value[x]	preferred	CommonSymptomCodes http://hl7.org/fhir/uv/symptoms/ValueSet/CommonSymptomCodes From this IG Additional Bindings Purpose SNOMEDCTClinicalFindings Max Binding
Observation.bodySite	preferred	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods|4.0.1 From the FHIR Standard
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1 From the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1 From the FHIR Standard
Observation.component.code	example	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:quality.code	example	Pattern Value: LOINC Code 56823-8("Problem quality or description") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:quality.value[x]	example	LOINC LL4459-5 http://loinc.org/vs/LL4459-5
Observation.component:severity.code	example	Pattern Value: LOINC Code 64750-3("Severity of symptoms") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:severity.value[x]	example	LOINC LL1156-0 http://loinc.org/vs/LL1156-0
Observation.component:functionalImpact.code	preferred	FunctionalClassification http://hl7.org/fhir/uv/symptoms/ValueSet/FunctionalClassification From this IG
Observation.component:clinicalCourse.code	example	Pattern Value: LOINC Code 89261-2("Clinical course") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:clinicalCourse.value[x]	example	LOINC LL4997-4 http://loinc.org/vs/LL4997-4
Observation.component:trend.code	example	Pattern Value: LOINC Code 89253-9("Trend") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:trend.value[x]	example	LOINC LL4938-8 http://loinc.org/vs/LL4938-8
Observation.component:affectiveGrade.code	example	Pattern Value: SNOMED-CT Code 279116004("Affective response to pain") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:affectiveGrade.value[x]	example	AffectiveGrade http://hl7.org/fhir/uv/symptoms/ValueSet/AffectiveGrade From this IG
Observation.component:triggersOrExacerbatingFactors.code	example	Pattern Value: LOINC Code 100752-5("Exacerbating factors - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:triggersOrExacerbatingFactors.value[x]	example	LOINC LL6278-7 http://loinc.org/vs/LL6278-7
Observation.component:alleviatingFactors.code	example	Pattern Value: LOINC Code 100753-3("Alleviating factors - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:alleviatingFactors.value[x]	example	LOINC LL6279-5 http://loinc.org/vs/LL6279-5
Observation.component:otherEvents.code	example	Pattern Value: LOINC Code 96542-6 http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:otherEvents.value[x]	example	LOINC LL361-7 http://loinc.org/vs/LL361-7
Observation.component:frequency.code	example	Pattern Value: LOINC Code 104156-5("Condition frequency - Reported") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:frequency.value[x]:valueRatio.denominator.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 From the FHIR Standard
Observation.component:frequency.value[x]:valueRatio.denominator.unit	required	CommonUCUMCodesForDuration http://hl7.org/fhir/ValueSet/duration-units From the FHIR Standard
Observation.component:frequency.value[x]:valueCodeableConcept	preferred	LOINC LL6514-5 http://loinc.org/vs/LL6514-5
Observation.component:speedOfOnset.code	example	Pattern Value: LOINC Code 99495-4("Speed of condition onset") http://hl7.org/fhir/ValueSet/observation-codes|4.0.1 From the FHIR Standard
Observation.component:speedOfOnset.value[x]	preferred	SpeedOfOnset http://hl7.org/fhir/uv/symptoms/ValueSet/SpeedOfOnset From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()