{
  "resourceType" : "Observation",
  "id" : "TxImp05",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/therapeutic-implication"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Poor metabolizer of Amitriptyline</div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact",
    "valueRelatedArtifact" : {
      "type" : "citation",
      "url" : "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/"
    }
  }],
  "status" : "final",
  "category" : [{
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
      "code" : "laboratory"
    }]
  },
  {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0074",
      "code" : "GE"
    }]
  }],
  "code" : {
    "coding" : [{
      "system" : "http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs",
      "code" : "therapeutic-implication"
    }]
  },
  "subject" : {
    "reference" : "Patient/CGPatientExample01"
  },
  "effectiveDateTime" : "2019-04-01",
  "performer" : [{
    "reference" : "Organization/ExampleOrg"
  }],
  "derivedFrom" : [{
    "reference" : "Observation/Pgx-geno-1001"
  }],
  "component" : [{
    "code" : {
      "coding" : [{
        "system" : "http://loinc.org",
        "code" : "51963-7"
      }]
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "704",
        "display" : "amitriptyline"
      }]
    }
  },
  {
    "code" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs",
        "code" : "therapeutic-implication"
      }]
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://loinc.org",
        "code" : "LA9657-3",
        "display" : "Poor metabolizer"
      }]
    }
  },
  {
    "code" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs",
        "code" : "conclusion-string"
      }]
    },
    "valueString" : "For amitriptyline, a 50% reduction in starting dose is recommended with therapeutic drug monitoring to guide dose adjustment. Refer to current guidelines for dosage and recommendations at https://cpicpgx.org/guidelines/guideline-for- tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/. If CYP2D6 genotyping is available, refer to the current guidelines for dosing recommendations."
  }]
}