RIVO-Noord Zorgviewer Implementation Guide
1.21.0 - CI build

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.21.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

## Resource Profile: VitalSign - Detailed Descriptions

Active as of 2025-10-28

Definitions for the VitalSign resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
Definition | Measurements and simple assertions made about a patient, device or other subject.
Short | Measurements and simple assertions
Comments | Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc.
Control | 0..*
Alternate Names | Vital Signs, Measurement, Results, Tests
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (`contained.text.empty()`) dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (`contained.where(('#'+id in %resource.descendants().reference).not()).empty()`) obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (`value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()`) obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (`dataAbsentReason.empty() or value.empty()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty()) dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty()) obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()) obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
2. Observation.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. Observation.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
6. Observation.status
Definition | The status of the result value.
Short | registered | preliminary | final | amended +
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from ObservationStatus http://hl7.org/fhir/ValueSet/observation-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/observation-status|3.0.2` ) Codes providing the status of an observation.
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to track the status of individual results. Some results are finalized before the whole report is finalized.
8. Observation.code
Definition | Describes what was observed. Sometimes this is called the observation "name".
Short | Type of observation (code / type)
Control | 1..1
Binding | For example codes, see LOINC Codes http://hl7.org/fhir/ValueSet/observation-codes|3.0.2 (example to `http://hl7.org/fhir/ValueSet/observation-codes|3.0.2` ) Codes identifying names of simple observations.
Type | CodeableConcept
Must Support | true
Summary | true
Requirements | Knowing what kind of observation is being made is essential to understanding the observation.
Alternate Names | Name
10. Observation.code.coding
Definition | A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Control | 0..*
Type | Coding
Must Support | true
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
12. Observation.code.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
14. Observation.effective[x]
Definition | The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Short | Clinically relevant time/time-period for observation
Comments | At least a date should be present unless this observation is a historical report.
Control | 0..1
Type | Choice of: dateTime, Period
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | Knowing when an observation was deemed true is important to its relevance as well as determining trends.
Alternate Names | Occurrence
16. Observation.performer
Definition | Who was responsible for asserting the observed value as "true".
Short | Who is responsible for the observation
Control | 0..*
Type | Reference(Practitioner, Organization, Patient, RelatedPerson)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
18. Observation.value[x]
Definition | The information determined as a result of making the observation, if the information has a simple value.
Short | Actual result
Comments | Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.
Control | 0..1 This element is affected by the following invariants: obs-7
Type | Choice of: Quantity, CodeableConcept, string, dateTime, boolean, SampledData, Period, Ratio, Attachment, time, Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: Quantity, CodeableConcept, string, dateTime, boolean, SampledData, Period, Ratio, Attachment, time, Range
Summary | true
Requirements | An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.
20. Observation.comment
Definition | May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result.
Short | Comments about result
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Requirements | Need to be able to provide free text additional information.
22. Observation.bodySite
Definition | Indicates the site on the subject's body where the observation was made (i.e. the target site).
Short | Observed body part
Comments | Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance.
Control | 0..1
Binding | For example codes, see SNOMED CT Body Structures http://hl7.org/fhir/ValueSet/body-site|3.0.2 (example to `http://hl7.org/fhir/ValueSet/body-site|3.0.2` ) Codes describing anatomical locations. May include laterality.
Type | CodeableConcept
Must Support | true
24. Observation.method
Definition | Indicates the mechanism used to perform the observation.
Short | How it was done
Comments | Only used if not implicit in code for Observation.code.
Control | 0..1
Binding | For example codes, see Observation Methods http://hl7.org/fhir/ValueSet/observation-methods|3.0.2 (example to `http://hl7.org/fhir/ValueSet/observation-methods|3.0.2` ) Methods for simple observations.
Type | CodeableConcept
Must Support | true
Requirements | In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
26. Observation.component
Definition | Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Short | Component results
Comments | For a discussion on the ways Observations can be assembled in groups together see Notes below.
Control | 0..*
Type | BackboneElement
Summary | true
Requirements | Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
28. Observation.component.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
30. Observation.component.code
Definition | Describes what was observed. Sometimes this is called the observation "code".
Short | Type of component observation (code / type)
Control | 1..1
Binding | For example codes, see LOINC Codes http://hl7.org/fhir/ValueSet/observation-codes|3.0.2 (example to `http://hl7.org/fhir/ValueSet/observation-codes|3.0.2` ) Codes identifying names of simple observations.
Type | CodeableConcept
Summary | true
Requirements | Knowing what kind of observation is being made is essential to understanding the observation.
32. Observation.component.value[x]
Definition | The information determined as a result of making the observation, if the information has a simple value.
Short | Actual component result
Comments | Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).
Control | 0..1
Type | Quantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Must Support | true
Must Support Types | Quantity
Summary | true
Requirements | An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
2. Observation.code
Must Support | true
4. Observation.code.coding
Must Support | true
6. Observation.code.text
Must Support | true
8. Observation.effective[x]
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Must Support | true
10. Observation.performer
Must Support | true
12. Observation.value[x]
Type | Choice of: Quantity, Added:CodeableConcept, Added:string, dateTime, boolean, SampledData, Period, Ratio, Attachment, time, Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: Quantity, Added:CodeableConcept, Added:string, dateTime, boolean, SampledData, Period, Ratio, Attachment, time, Range
14. Observation.comment
Must Support | true
16. Observation.bodySite
Must Support | true
18. Observation.method
Must Support | true
20. Observation.component
Added: 22. Observation.component.value[x]
Type | Quantity, dateTime, string, SampledData, Period, Ratio, Attachment, time, Range, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Must Support | true
Must Support Types | Quantity

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
Definition | Measurements and simple assertions made about a patient, device or other subject.
Short | Measurements and simple assertions
Comments | Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc.
Control | 0..*
Alternate Names | Vital Signs, Measurement, Results, Tests
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (`contained.text.empty()`) dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (`contained.where(('#'+id in %resource.descendants().reference).not()).empty()`) obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (`value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()`) obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (`dataAbsentReason.empty() or value.empty()`)
2. Observation.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Control | 0..1
Type | id
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. Observation.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Summary | true
6. Observation.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
8. Observation.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to `http://hl7.org/fhir/ValueSet/languages|3.0.2` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
10. Observation.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
12. Observation.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
14. Observation.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
16. Observation.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
18. Observation.identifier
Definition | A unique identifier assigned to this observation.
Short | Business Identifier for observation
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Summary | true
Requirements | Allows observations to be distinguished and referenced.
20. Observation.basedOn
Definition | A plan, proposal or order that is fulfilled in whole or in part by this event.
Short | Fulfills plan, proposal or order
Control | 0..*
Type | Reference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ProcedureRequest, ReferralRequest)
Summary | true
Requirements | Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
Alternate Names | Fulfills
22. Observation.status
Definition | The status of the result value.
Short | registered | preliminary | final | amended +
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from ObservationStatus (required to `http://hl7.org/fhir/ValueSet/observation-status|3.0.2` ) Codes providing the status of an observation.
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to track the status of individual results. Some results are finalized before the whole report is finalized.
24. Observation.category
Definition | A code that classifies the general type of observation being made.
Short | Classification of type of observation
Comments | In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
Control | 0..*
Binding | The codes SHOULD be taken from Observation Category Codes (preferred to `http://hl7.org/fhir/ValueSet/observation-category|3.0.2` ) Codes for high level observation categories.
Type | CodeableConcept
Requirements | Used for filtering what observations are retrieved and displayed.
26. Observation.code
Definition | Describes what was observed. Sometimes this is called the observation "name".
Short | Type of observation (code / type)
Control | 1..1
Binding | For example codes, see LOINC Codes (example to `http://hl7.org/fhir/ValueSet/observation-codes|3.0.2` ) Codes identifying names of simple observations.
Type | CodeableConcept
Must Support | true
Summary | true
Requirements | Knowing what kind of observation is being made is essential to understanding the observation.
Alternate Names | Name
28. Observation.code.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
30. Observation.code.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `Observation.code.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
32. Observation.code.coding
Definition | A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Control | 0..*
Type | Coding
Must Support | true
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
34. Observation.code.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
36. Observation.subject
Definition | The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.
Short | Who and/or what this is about
Comments | One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.
Control | 0..1
Type | Reference(Patient, Group, Device, Location)
Summary | true
Requirements | Observations have no value if you don't know who or what they're about.
38. Observation.context
Definition | The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Short | Healthcare event during which this observation is made
Comments | This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).
Control | 0..1
Type | Reference(Encounter, EpisodeOfCare)
Requirements | For some observations it may be important to know the link between an observation and a particular encounter.
Alternate Names | Encounter
40. Observation.effective[x]
Definition | The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Short | Clinically relevant time/time-period for observation
Comments | At least a date should be present unless this observation is a historical report.
Control | 0..1
Type | Choice of: dateTime, Period
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | Knowing when an observation was deemed true is important to its relevance as well as determining trends.
Alternate Names | Occurrence
42. Observation.issued
Definition | The date and time this observation was made available to providers, typically after the results have been reviewed and verified.
Short | Date/Time this was made available
Comments | Updated when the result is updated.
Control | 0..1
Type | instant
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
44. Observation.performer
Definition | Who was responsible for asserting the observed value as "true".
Short | Who is responsible for the observation
Control | 0..*
Type | Reference(Practitioner, Organization, Patient, RelatedPerson)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
46. Observation.value[x]
Definition | The information determined as a result of making the observation, if the information has a simple value.
Short | Actual result
Comments | Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.
Control | 0..1 This element is affected by the following invariants: obs-7
Type | Choice of: Quantity, CodeableConcept, string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | Choice of: Quantity, CodeableConcept, string
Summary | true
Requirements | An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.
48. Observation.dataAbsentReason
Definition | Provides a reason why the expected value in the element Observation.value[x] is missing.
Short | Why the result is missing
Comments | Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
Control | 0..1 This element is affected by the following invariants: obs-6
Binding | Unless not suitable, these codes SHALL be taken from Observation Value Absent Reason (extensible to `http://hl7.org/fhir/ValueSet/observation-valueabsentreason|3.0.2` ) Codes specifying why the result (Observation.value[x]) is missing.
Type | CodeableConcept
Requirements | For many results it is necessary to handle exceptional values in measurements.
50. Observation.interpretation
Definition | The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
Short | High, low, normal, etc.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Observation Interpretation Codes (extensible to `http://hl7.org/fhir/ValueSet/observation-interpretation|3.0.2` ) Codes identifying interpretations of observations.
Type | CodeableConcept
Requirements | For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Alternate Names | Abnormal Flag
52. Observation.comment
Definition | May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result.
Short | Comments about result
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Requirements | Need to be able to provide free text additional information.
54. Observation.bodySite
Definition | Indicates the site on the subject's body where the observation was made (i.e. the target site).
Short | Observed body part
Comments | Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance.
Control | 0..1
Binding | For example codes, see SNOMED CT Body Structures (example to `http://hl7.org/fhir/ValueSet/body-site|3.0.2` ) Codes describing anatomical locations. May include laterality.
Type | CodeableConcept
Must Support | true
56. Observation.method
Definition | Indicates the mechanism used to perform the observation.
Short | How it was done
Comments | Only used if not implicit in code for Observation.code.
Control | 0..1
Binding | For example codes, see Observation Methods (example to `http://hl7.org/fhir/ValueSet/observation-methods|3.0.2` ) Methods for simple observations.
Type | CodeableConcept
Must Support | true
Requirements | In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
58. Observation.specimen
Definition | The specimen that was used when this observation was made.
Short | Specimen used for this observation
Comments | Should only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).
Control | 0..1
Type | Reference(Specimen)
60. Observation.device
Definition | The device used to generate the observation data.
Short | (Measurement) Device
Comments | An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.
Control | 0..1
Type | Reference(Device, DeviceMetric)
62. Observation.referenceRange
Definition | Guidance on how to interpret the value by comparison to a normal or recommended range.
Short | Provides guide for interpretation
Comments | Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Control | 0..*
Type | BackboneElement
Requirements | Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) obs-3: Must have at least a low or a high or text (`low.exists() or high.exists() or text.exists()`)
64. Observation.referenceRange.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
66. Observation.referenceRange.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
68. Observation.referenceRange.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
70. Observation.referenceRange.low
Definition | The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
Short | Low Range, if relevant
Control | 0..1 This element is affected by the following invariants: obs-3
Type | Quantity(SimpleQuantity)
72. Observation.referenceRange.high
Definition | The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
Short | High Range, if relevant
Control | 0..1 This element is affected by the following invariants: obs-3
Type | Quantity(SimpleQuantity)
74. Observation.referenceRange.type
Definition | Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Short | Reference range qualifier
Comments | This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Observation Reference Range Meaning Codes (extensible to `http://hl7.org/fhir/ValueSet/referencerange-meaning|3.0.2` ) Code for the meaning of a reference range.
Type | CodeableConcept
Requirements | Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation.
76. Observation.referenceRange.appliesTo
Definition | Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race.
Short | Reference range population
Comments | This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Control | 0..*
Binding | For example codes, see Observation Reference Range Applies To Codes (example to `http://hl7.org/fhir/ValueSet/referencerange-appliesto|3.0.2` ) Codes identifying the population the reference range applies to.
Type | CodeableConcept
Requirements | Need to be able to identify the target population for proper interpretation.
78. Observation.referenceRange.age
Definition | The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Short | Applicable age range, if relevant
Control | 0..1
Type | Range
Requirements | Some analytes vary greatly over age.
80. Observation.referenceRange.text
Definition | Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of 'normals'.
Short | Text based reference range in an observation
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
82. Observation.related
Definition | A reference to another resource (usually another Observation) whose relationship is defined by the relationship type code.
Short | Resource related to this observation
Comments | For a discussion on the ways Observations can assembled in groups together see Notes below.
Control | 0..*
Type | BackboneElement
Summary | true
Requirements | Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
84. Observation.related.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
86. Observation.related.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
88. Observation.related.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
90. Observation.related.type
Definition | A code specifying the kind of relationship that exists with the target resource.
Short | has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Comments | The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.
Control | 0..1
Binding | The codes SHALL be taken from ObservationRelationshipType (required to `http://hl7.org/fhir/ValueSet/observation-relationshiptypes|3.0.2` ) Codes specifying how two observations are related.
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Requirements | A relationship type SHOULD be provided.
92. Observation.related.target
Definition | A reference to the observation or QuestionnaireResponse resource that is related to this observation.
Short | Resource that is related to this one
Control | 1..1
Type | Reference(Observation, QuestionnaireResponse, Sequence)
94. Observation.component
Definition | Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Short | Component results
Comments | For a discussion on the ways Observations can be assembled in groups together see Notes below.
Control | 0..*
Type | BackboneElement
Summary | true
Requirements | Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
96. Observation.component.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
98. Observation.component.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
100. Observation.component.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
102. Observation.component.code
Definition | Describes what was observed. Sometimes this is called the observation "code".
Short | Type of component observation (code / type)
Control | 1..1
Binding | For example codes, see LOINC Codes (example to `http://hl7.org/fhir/ValueSet/observation-codes|3.0.2` ) Codes identifying names of simple observations.
Type | CodeableConcept
Summary | true
Requirements | Knowing what kind of observation is being made is essential to understanding the observation.
104. Observation.component.value[x]
Definition | The information determined as a result of making the observation, if the information has a simple value.
Short | Actual component result
Comments | Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).
Control | 0..1
Type | Quantity
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Must Support | true
Must Support Types | Quantity
Summary | true
Requirements | An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.
106. Observation.component.dataAbsentReason
Definition | Provides a reason why the expected value in the element Observation.value[x] is missing.
Short | Why the component result is missing
Comments | "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
Control | 0..1 This element is affected by the following invariants: obs-6
Binding | Unless not suitable, these codes SHALL be taken from Observation Value Absent Reason (extensible to `http://hl7.org/fhir/ValueSet/observation-valueabsentreason|3.0.2` ) Codes specifying why the result (Observation.value[x]) is missing.
Type | CodeableConcept
Requirements | For many results it is necessary to handle exceptional values in measurements.
108. Observation.component.interpretation
Definition | The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
Short | High, low, normal, etc.
Comments | The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Observation Interpretation Codes (extensible to `http://hl7.org/fhir/ValueSet/observation-interpretation|3.0.2` ) Codes identifying interpretations of observations.
Type | CodeableConcept
Requirements | For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Alternate Names | Abnormal Flag
110. Observation.component.referenceRange
Definition | Guidance on how to interpret the value by comparison to a normal or recommended range.
Short | Provides guide for interpretation of component result
Comments | Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
Requirements | Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.