Kenya Emergency FHIR Implementation Guide
0.1.0 - ci-build Kenya flag

Kenya Emergency FHIR Implementation Guide, published by Digital Health Agency (DHA), Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/Kenya-Emmergency-FHIR-IG/ and changes regularly. See the Directory of published versions

Resource Profile: Observation - Emergency Secondary Survey

Official URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-secondary-survey-observation Version: 0.1.0
Active as of 2026-07-20 Computable Name: EMSecondarySurveyObservation

Represents the examination of a single body region during an emergency secondary survey — one Observation instance per body region examined (head, neck, chest, back-and-spine, abdomen, pelvis, upper-extremities, lower-extremities), not one Observation for the whole secondary survey.

Mirrors the explicit-absence pattern used on EMAllergyIntolerance: a region with nothing abnormal found must be recorded as an explicit "examined, no findings" Observation, never left as a silently-missing resource. A full-body exam is expected to produce exactly 8 Observation instances (fewer only if the survey was genuinely partial, e.g. limited by scene safety) — that expectation is a workflow-completeness rule, not a FHIR structural constraint on this profile.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: obs-6, obs-7, em-exam-1, em-exam-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... category S 1..1 CodeableConcept Fixed to 'exam'
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identifies this as a secondary-survey examination of a specific region
Binding: Emergency Secondary Survey Region Value Set (required)
... subject SΣ 1..1 Reference(Patient) Patient examined
... encounter SΣ 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] Σ 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime SΣ 1..1 dateTime When this region was examined
... performer SΣ 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] SΣC 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... component SΣ 0..* BackboneElement Discrete findings when more than one applies to the same region
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📍4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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())
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true
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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: em-exam-1, em-exam-2
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... status S 1..1 code Workflow status of the exam finding
Binding: ObservationStatus (required)
... category S 1..1 CodeableConcept Fixed to 'exam'
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://terminology.hl7.org/CodeSystem/observation-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
... subject S 1..1 Reference(Patient) Patient examined
... encounter S 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Open by type:$this
.... effective[x]:effectiveDateTime S 1..1 dateTime When this region was examined
... performer S 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] S 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... component S 0..* BackboneElement Discrete findings when more than one applies to the same region
.... code S 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: obs-6, obs-7, em-exam-1, em-exam-2
... 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 BindingsPurpose
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 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... 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 Workflow status of the exam finding
Binding: ObservationStatus (required)
... category S 1..1 CodeableConcept Fixed to 'exam'
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identifies this as a secondary-survey examination of a specific region
Binding: Emergency Secondary Survey Region Value Set (required)
... subject SΣ 1..1 Reference(Patient) Patient examined
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter SΣ 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] Σ 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime SΣ 1..1 dateTime When this region was examined
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] SΣC 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... 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
... component SΣ 0..* BackboneElement Discrete findings when more than one applies to the same region
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📍4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.method Base example Observation Methods 📍4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📍4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📍4.0.1 FHIR Std.
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.component.​interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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())
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-3 error Observation.referenceRange Must have at least a low or a high or text low.exists() or high.exists() or text.exists()
obs-6 error Observation dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty()
obs-7 error Observation If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from Observation

Summary

Mandatory: 8 elements
Must-Support: 12 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.effective[x]

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: obs-6, obs-7, em-exam-1, em-exam-2
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... category S 1..1 CodeableConcept Fixed to 'exam'
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identifies this as a secondary-survey examination of a specific region
Binding: Emergency Secondary Survey Region Value Set (required)
... subject SΣ 1..1 Reference(Patient) Patient examined
... encounter SΣ 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] Σ 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime SΣ 1..1 dateTime When this region was examined
... performer SΣ 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] SΣC 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... component SΣ 0..* BackboneElement Discrete findings when more than one applies to the same region
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📍4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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())
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true
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()

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: em-exam-1, em-exam-2
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... status S 1..1 code Workflow status of the exam finding
Binding: ObservationStatus (required)
... category S 1..1 CodeableConcept Fixed to 'exam'
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://terminology.hl7.org/CodeSystem/observation-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
... subject S 1..1 Reference(Patient) Patient examined
... encounter S 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Open by type:$this
.... effective[x]:effectiveDateTime S 1..1 dateTime When this region was examined
... performer S 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] S 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... component S 0..* BackboneElement Discrete findings when more than one applies to the same region
.... code S 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Observation C 0..* Observation Measurements and simple assertions
Constraints: obs-6, obs-7, em-exam-1, em-exam-2
... 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 BindingsPurpose
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 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:noFindingsOnExam S 1..1 boolean Explicit flag confirming this region was examined and nothing abnormal was found
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam
... 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 Workflow status of the exam finding
Binding: ObservationStatus (required)
... category S 1..1 CodeableConcept Fixed to 'exam'
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: exam
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identifies this as a secondary-survey examination of a specific region
Binding: Emergency Secondary Survey Region Value Set (required)
... subject SΣ 1..1 Reference(Patient) Patient examined
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter SΣ 1..1 Reference(Encounter) Associated encounter, typically EMPOCEncounter
... Slices for effective[x] Σ 1..1 dateTime Clinically relevant time/time-period for observation
Slice: Unordered, Closed by type:$this
.... effective[x]:effectiveDateTime SΣ 1..1 dateTime When this region was examined
... issued Σ 0..1 instant Date/Time this version was made available
... performer SΣ 0..1 Reference(Practitioner | PractitionerRole) Who performed the exam
... value[x] SΣC 0..1 CodeableConcept The abnormal finding for this region
Binding: SNOMEDCTClinicalFindings (extensible)
... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
... note 0..* Annotation Free-text notes about the regional exam
... bodySite S 1..1 CodeableConcept The body region examined
Binding: Emergency Body Region Value Set (required)
... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.
... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
Constraints: obs-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity(4.0.1) Low Range, if relevant
.... high C 0..1 SimpleQuantity(4.0.1) High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... 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
... component SΣ 0..* BackboneElement Discrete findings when more than one applies to the same region
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 1..1 CodeableConcept Type of component observation (code / type)
Binding: SNOMEDCTClinicalFindings (extensible)
.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Observation.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Observation.status Base required ObservationStatus 📦4.0.1 FHIR Std.
Observation.category Base preferred Observation Category Codes 📍4.0.1 FHIR Std.
Observation.code Base required Emergency Secondary Survey Region Value Set 📦0.1.0 This IG
Observation.value[x] Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.
Observation.bodySite Base required Emergency Body Region Value Set 📦0.1.0 This IG
Observation.method Base example Observation Methods 📍4.0.1 FHIR Std.
Observation.referenceRange.​type Base preferred Observation Reference Range Meaning Codes 📍4.0.1 FHIR Std.
Observation.referenceRange.​appliesTo Base example Observation Reference Range Applies To Codes 📍4.0.1 FHIR Std.
Observation.component.​code Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
Observation.component.​dataAbsentReason Base extensible DataAbsentReason 📍4.0.1 FHIR Std.
Observation.component.​interpretation Base extensible Observation Interpretation Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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())
em-exam-1 error Observation The noFindingsOnExam extension must agree with whether any finding was coded: true only when no finding is present, false whenever a finding is coded. (value.exists() or component.exists()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = false
em-exam-2 error Observation When no finding is coded, the noFindingsOnExam extension must be true. (value.empty() and component.empty()) implies extension.where(url = 'https://nshr-uat.sha.go.ke/fhir/StructureDefinition/em-no-findings-on-exam').value.ofType(boolean) = true
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
obs-3 error Observation.referenceRange Must have at least a low or a high or text low.exists() or high.exists() or text.exists()
obs-6 error Observation dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty()
obs-7 error Observation If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from Observation

Summary

Mandatory: 8 elements
Must-Support: 12 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.effective[x]

 

Other representations of profile: CSV, Excel, Schematron