RIVO-Noord Zorgviewer Implementation Guide
1.23.0 - 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 1.23.0 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: LivingSituation - XML Profile

Active as of 2026-03-30

XML representation of the LivingSituation resource profile.

Raw xml | Download

    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="LivingSituation"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition LivingSituation</b></p><a name="LivingSituation"> </a><a name="hcLivingSituation"> </a><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64, " alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-LivingSituation-definitions.html#Observation">Observation</a><a name="Observation"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://simplifier.net/resolve?scope=nictiz.fhir.nl.stu3.zib2017@2.3.2&amp;canonical=http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation">Zib LivingSituation</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">LivingSituation</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-LivingSituation-definitions.html#Observation.valueCodeableConcept">valueCodeableConcept</a><a name="Observation.valueCodeableConcept"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-LivingSituation-definitions.html#Observation.valueCodeableConcept.text">text</a><a name="Observation.valueCodeableConcept.text"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/STU3/datatypes.html#string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Plain text representation of the concept</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-LivingSituation-definitions.html#Observation.comment">comment</a><a name="Observation.comment"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/STU3/datatypes.html#string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Comment</span></td></tr>
    <tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64, " alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
      </text>
      <url
           value="http://fhir.hl7.nl/zorgviewer/StructureDefinition/LivingSituation"/>
      <version value="1.23.0"/>
      <name value="LivingSituation"/>
      <title value="LivingSituation"/>
      <status value="active"/>
      <date value="2026-03-30T13:23:57+00:00"/>
      <publisher value="RIVO-NN HL7NL"/>
      <contact>
        <name value="RIVO-NN"/>
        <telecom>
          <system value="url"/>
          <value value="https://rivo-noord.nl"/>
        </telecom>
      </contact>
      <contact>
        <name value="HL7NL"/>
        <telecom>
          <system value="url"/>
          <value value="https://hl7.nl"/>
        </telecom>
      </contact>
      <description value="Woonsituatie"/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="NL"/>
        </coding>
      </jurisdiction>
      <fhirVersion value="3.0.2"/>
      <mapping>
        <identity value="hcim-livingsituation-v3.1-2017EN"/>
        <uri value="https://zibs.nl/wiki/LivingSituation-v3.1(2017EN)"/>
        <name value="HCIM LivingSituation-v3.1(2017EN)"/>
      </mapping>
      <mapping>
        <identity value="hcim-basicelements-v1.0-2017EN"/>
        <uri value="https://zibs.nl/wiki/BasicElements-v1.0(2017EN)"/>
        <name value="HCIM BasicElements-v1.0(2017EN)"/>
      </mapping>
      <mapping>
        <identity value="hcim-livingsituation-3.0-2016EN"/>
        <uri value="https://zibs.nl/wiki/LivingSituation-v3.0(2016EN)"/>
        <name value="HCIM LivingSituation-v3.0(2016EN)"/>
      </mapping>
      <mapping>
        <identity value="hcim-livingsituation-v1.2-2015EN"/>
        <uri value="https://zibs.nl/wiki/LivingSituation-v1.2(2015EN)"/>
        <name value="HCIM LivingSituation-v1.2(2015EN)"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="false"/>
      <type value="Observation"/>
      <baseDefinition
                      value="http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation"/>
      <derivation value="constraint"/>
      <snapshot>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
          <valueString value="2.1.5"/>
        </extension>
        <element id="Observation">
          <path value="Observation"/>
          <short value="LivingSituation"/>
          <definition
                      value="Measurements and simple assertions made about a patient, device or other subject."/>
          <comment
                   value="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."/>
          <alias value="Vital Signs"/>
          <alias value="Measurement"/>
          <alias value="Results"/>
          <alias value="Tests"/>
          <alias value="Woonsituatie"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Resource"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <constraint>
            <key value="dom-2"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
            <expression value="contained.contained.empty()"/>
            <xpath value="not(parent::f:contained and f:contained)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-1"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain any narrative"/>
            <expression value="contained.text.empty()"/>
            <xpath value="not(parent::f:contained and f:text)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-4"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
            <expression
                        value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
            <xpath
                   value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-3"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource"/>
            <expression
                        value="contained.where(('#'+id in %resource.descendants().reference).not()).empty()"/>
            <xpath
                   value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="obs-7"/>
            <severity value="error"/>
            <human
                   value="If code is the same as a component code then the value element associated with the code SHALL NOT be present"/>
            <expression
                        value="value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()"/>
            <xpath
                   value="not(exists(f:*[starts-with(local-name(.), 'value')])) or not(count(for $coding in f:code/f:coding return parent::*/f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value and f:system/@value=$coding/f:system/@value])=0)"/>
            <source
                    value="http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation"/>
          </constraint>
          <constraint>
            <key value="obs-6"/>
            <severity value="error"/>
            <human
                   value="dataAbsentReason SHALL only be present if Observation.value[x] is not present"/>
            <expression value="dataAbsentReason.empty() or value.empty()"/>
            <xpath
                   value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))"/>
            <source
                    value="http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="workflow"/>
            <map value="Event"/>
          </mapping>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 363787002 |Observable entity|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="Observation[classCode=OBS, moodCode=EVN]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="clinical.diagnostics"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v1.2-2015EN"/>
            <map value="NL-CM:7.8.1"/>
            <comment value="LivingSituation"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-3.0-2016EN"/>
            <map value="NL-CM:7.8.1"/>
            <comment value="LivingSituation"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v3.1-2017EN"/>
            <map value="NL-CM:7.8.1"/>
            <comment value="LivingSituation"/>
          </mapping>
        </element>
        <element id="Observation.id">
          <path value="Observation.id"/>
          <short value="Logical id of this artifact"/>
          <definition
                      value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
          <comment
                   value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="id"/>
          </type>
          <isSummary value="true"/>
        </element>
        <element id="Observation.meta">
          <path value="Observation.meta"/>
          <short value="Metadata about the resource"/>
          <definition
                      value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.meta"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Meta"/>
          </type>
          <isSummary value="true"/>
        </element>
        <element id="Observation.implicitRules">
          <path value="Observation.implicitRules"/>
          <short value="A set of rules under which this content was created"/>
          <definition
                      value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content."/>
          <comment
                   value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.implicitRules"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <isModifier value="true"/>
          <isSummary value="true"/>
        </element>
        <element id="Observation.language">
          <path value="Observation.language"/>
          <short value="Language of the resource content"/>
          <definition
                      value="The base language in which the resource is written."/>
          <comment
                   value="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)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
              <valueReference>🔗
                <reference value="http://hl7.org/fhir/ValueSet/all-languages"/>
              </valueReference>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <strength value="extensible"/>
            <description value="A human language."/>
            <valueSetReference>🔗
              <reference value="http://hl7.org/fhir/ValueSet/languages"/>
            </valueSetReference>
          </binding>
        </element>
        <element id="Observation.text">
          <path value="Observation.text"/>
          <short value="Text summary of the resource, for human interpretation"/>
          <definition
                      value="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 &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
          <comment
                   value="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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded in formation is added later."/>
          <alias value="narrative"/>
          <alias value="html"/>
          <alias value="xhtml"/>
          <alias value="display"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Narrative"/>
          </type>
          <condition value="dom-1"/>
          <mapping>
            <identity value="rim"/>
            <map value="Act.text?"/>
          </mapping>
        </element>
        <element id="Observation.contained">
          <path value="Observation.contained"/>
          <short value="Contained, inline Resources"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="inline resources"/>
          <alias value="anonymous resources"/>
          <alias value="contained resources"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.contained"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Resource"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.extension">
          <path value="Observation.extension"/>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.modifierExtension">
          <path value="Observation.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <isModifier value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.identifier">
          <path value="Observation.identifier"/>
          <short value="Business Identifier for observation"/>
          <definition value="A unique identifier assigned to this observation."/>
          <requirements
                        value="Allows observations to be distinguished and referenced."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.identifier"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.identifier"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="OBX.21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4."/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="id"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="id"/>
          </mapping>
          <mapping>
            <identity value="hcim-basicelements-v1.0-2017EN"/>
            <map value="NL-CM:0.0.6"/>
            <comment value="IdentificationNumber"/>
          </mapping>
        </element>
        <element id="Observation.basedOn">
          <path value="Observation.basedOn"/>
          <short value="Fulfills plan, proposal or order"/>
          <definition
                      value="A plan, proposal or order that is fulfilled in whole or in part by this event."/>
          <requirements
                        value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon."/>
          <alias value="Fulfills"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.basedOn"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CarePlan"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DeviceRequest"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ProcedureRequest"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ReferralRequest"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.basedOn"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ORC"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode=FLFS].target"/>
          </mapping>
        </element>
        <element id="Observation.status">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
            <valueString value="default: final"/>
          </extension>
          <path value="Observation.status"/>
          <short value="registered | preliminary | final | amended +"/>
          <definition value="The status of the result value."/>
          <comment
                   value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
          <requirements
                        value="Need to track the status of individual results. Some results are finalized before the whole report is finalized."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Observation.status"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <isModifier value="true"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationStatus"/>
            </extension>
            <strength value="required"/>
            <description value="Codes providing the status of an observation."/>
            <valueSetReference>🔗
              <reference value="http://hl7.org/fhir/ValueSet/observation-status"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.status"/>
          </mapping>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 445584004 |Report by finality status|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-11"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct event with a type of &quot;revise&quot;"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="status"/>
          </mapping>
        </element>
        <element id="Observation.category">
          <path value="Observation.category"/>
          <short value="Classification of  type of observation"/>
          <definition
                      value="A code that classifies the general type of observation being made."/>
          <comment
                   value="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."/>
          <requirements
                        value="Used for filtering what observations are retrieved and displayed."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.category"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationCategory"/>
            </extension>
            <strength value="preferred"/>
            <description value="Codes for high level observation categories."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-category"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="class"/>
          </mapping>
        </element>
        <element id="Observation.code">
          <path value="Observation.code"/>
          <short value="Type of observation (code / type)"/>
          <definition
                      value="Describes what was observed. Sometimes this is called the observation &quot;name&quot;."/>
          <requirements
                        value="Knowing what kind of observation is being made is essential to understanding the observation."/>
          <alias value="Name"/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Observation.code"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationCode"/>
            </extension>
            <strength value="example"/>
            <description value="Codes identifying names of simple observations."/>
            <valueSetReference>🔗
              <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.code"/>
          </mapping>
          <mapping>
            <identity value="sct-concept"/>
            <map
                 value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-3"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="code"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="116680003 |Is a|"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="what"/>
          </mapping>
        </element>
        <element id="Observation.code.id">
          <path value="Observation.code.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.code.extension">
          <path value="Observation.code.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.code.coding">
          <path value="Observation.code.coding"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="system"/>
            </discriminator>
            <discriminator>
              <type value="value"/>
              <path value="code"/>
            </discriminator>
            <rules value="open"/>
          </slicing>
          <short value="Code defined by a terminology system"/>
          <definition
                      value="A reference to a code defined by a terminology system."/>
          <comment
                   value="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."/>
          <requirements
                        value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings."/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="CodeableConcept.coding"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.1-8, C*E.10-22"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="union(., ./translation)"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode">
          <path value="Observation.code.coding"/>
          <sliceName value="livingSituationCode"/>
          <short value="Code defined by a terminology system"/>
          <definition
                      value="A reference to a code defined by a terminology system."/>
          <comment
                   value="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."/>
          <requirements
                        value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="CodeableConcept.coding"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.1-8, C*E.10-22"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="union(., ./translation)"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.id">
          <path value="Observation.code.coding.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.extension">
          <path value="Observation.code.coding.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.system">
          <path value="Observation.code.coding.system"/>
          <short value="Identity of the terminology system"/>
          <definition
                      value="The identification of the code system that defines the meaning of the symbol in the code."/>
          <comment
                   value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously."/>
          <requirements
                        value="Need to be unambiguous about the source of the definition of the symbol."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Coding.system"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <fixedUri value="http://snomed.info/sct"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.3"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./codeSystem"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.version">
          <path value="Observation.code.coding.version"/>
          <short value="Version of the system - if relevant"/>
          <definition
                      value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged."/>
          <comment
                   value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Coding.version"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./codeSystemVersion"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.code">
          <path value="Observation.code.coding.code"/>
          <short value="Symbol in syntax defined by the system"/>
          <definition
                      value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)."/>
          <requirements
                        value="Need to refer to a particular code in the system."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Coding.code"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <fixedCode value="365508006"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.1"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./code"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.display">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="Observation.code.coding.display"/>
          <short value="Representation defined by the system"/>
          <definition
                      value="A representation of the meaning of the code in the system, following the rules of the system."/>
          <requirements
                        value="Need to be able to carry a human-readable meaning of the code for readers that do not know  the system."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Coding.display"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <defaultValueString
                              value="Finding of residence and accommodation circumstances (finding)"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.2 - but note this is not well followed"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="CV.displayName"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/>
          </mapping>
        </element>
        <element id="Observation.code.coding:livingSituationCode.userSelected">
          <path value="Observation.code.coding.userSelected"/>
          <short value="If this coding was chosen directly by the user"/>
          <definition
                      value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)."/>
          <comment
                   value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely."/>
          <requirements
                        value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Coding.userSelected"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="boolean"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="Sometimes implied by being first"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="CD.codingRationale"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;     fhir:target dt:CDCoding.codingRationale\#O   ]"/>
          </mapping>
        </element>
        <element id="Observation.code.text">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="Observation.code.text"/>
          <short value="Plain text representation of the concept"/>
          <definition
                      value="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."/>
          <comment
                   value="Very often the text is the same as a displayName of one of the codings."/>
          <requirements
                        value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="CodeableConcept.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.9. But note many systems use C*E.2 for this"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/>
          </mapping>
        </element>
        <element id="Observation.subject">
          <path value="Observation.subject"/>
          <short value="Who and/or what this is about"/>
          <definition
                      value="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."/>
          <comment
                   value="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](http://hl7.org/fhir/STU3/extension-observation-focal-subject.html).  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."/>
          <requirements
                        value="Observations have no value if you don't know who or what they're about."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Observation.subject"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Device"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-location"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-patient"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.subject"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="PID-3"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="participation[typeCode=SBJ]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="who.focus"/>
          </mapping>
          <mapping>
            <identity value="hcim-basicelements-v1.0-2017EN"/>
            <map value="NL-CM:0.0.11"/>
            <comment value="Subject"/>
          </mapping>
        </element>
        <element id="Observation.context">
          <path value="Observation.context"/>
          <short value="Healthcare event during which this observation is made"/>
          <definition
                      value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made."/>
          <comment
                   value="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)."/>
          <requirements
                        value="For some observations it may be important to know the link between an observation and a particular encounter."/>
          <alias value="Encounter"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.context"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://nictiz.nl/fhir/StructureDefinition/zib-Encounter"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://nictiz.nl/fhir/StructureDefinition/gp-Encounter"/>
          </type>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.context"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="PV1"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="context"/>
          </mapping>
        </element>
        <element id="Observation.effective[x]">
          <path value="Observation.effective[x]"/>
          <short value="Clinically relevant time/time-period for observation"/>
          <definition
                      value="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 &quot;physiologically relevant time&quot;. 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."/>
          <comment
                   value="At least a date should be present unless this observation is a historical report."/>
          <requirements
                        value="Knowing when an observation was deemed true is important to its relevance as well as determining trends."/>
          <alias value="Occurrence"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.effective[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="dateTime"/>
          </type>
          <type>
            <code value="Period"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.occurrence[x]"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="effectiveTime"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="when.done"/>
          </mapping>
          <mapping>
            <identity value="hcim-basicelements-v1.0-2017EN"/>
            <map value="NL-CM:0.0.14"/>
            <comment value="DateTime"/>
          </mapping>
        </element>
        <element id="Observation.issued">
          <path value="Observation.issued"/>
          <short value="Date/Time this was made available"/>
          <definition
                      value="The date and time this observation was made available to providers, typically after the results have been reviewed and verified."/>
          <comment value="Updated when the result is updated."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.issued"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="instant"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map
                 value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="participation[typeCode=AUT].time"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="when.recorded"/>
          </mapping>
        </element>
        <element id="Observation.performer">
          <path value="Observation.performer"/>
          <short value="Who is responsible for the observation"/>
          <definition
                      value="Who was responsible for asserting the observed value as &quot;true&quot;."/>
          <requirements
                        value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.performer"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-organization"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-patient"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="OBX.15 / (Practitioner)  OBX-16,  PRT-5:PRT-4='RO' /  (Device)  OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization)  OBX-23,  PRT-8:PRT-4='PO'"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="participation[typeCode=PRF]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="who.actor"/>
          </mapping>
          <mapping>
            <identity value="hcim-basicelements-v1.0-2017EN"/>
            <map value="NL-CM:0.0.7"/>
            <comment value="Author"/>
          </mapping>
        </element>
        <element id="Observation.performer.id">
          <path value="Observation.performer.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.performer.extension">
          <path value="Observation.performer.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.performer.extension:practitionerRole">
          <path value="Observation.performer.extension"/>
          <sliceName value="practitionerRole"/>
          <short value="Optional Extensions Element"/>
          <definition
                      value="Optional Extension Element - found in all resources."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
            <profile
                     value="http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() | (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source
                    value="http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.performer.reference">
          <path value="Observation.performer.reference"/>
          <short value="Literal reference, Relative, internal or absolute URL"/>
          <definition
                      value="A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources."/>
          <comment
                   value="Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure &quot;/[type]/[id]&quot; then it should be assumed that the reference is to a FHIR RESTful server."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Reference.reference"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <condition value="ref-1"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.performer.identifier">
          <path value="Observation.performer.identifier"/>
          <short value="Logical reference, when literal reference is not known"/>
          <definition
                      value="An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference."/>
          <comment
                   value="When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Reference.identifier"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value=".identifier"/>
          </mapping>
        </element>
        <element id="Observation.performer.display">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="Observation.performer.display"/>
          <short value="Text alternative for the resource"/>
          <definition
                      value="Plain text narrative that identifies the resource in addition to the resource reference."/>
          <comment
                   value="This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Reference.display"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.valueCodeableConcept:valueCodeableConcept">
          <path value="Observation.valueCodeableConcept"/>
          <sliceName value="valueCodeableConcept"/>
          <short value="TypeOfHome"/>
          <definition value="Type of home the patient lives in."/>
          <comment
                   value="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 &quot;'value' + the type name&quot; 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](http://hl7.org/fhir/STU3/observation.html#notes) below."/>
          <requirements
                        value="An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations."/>
          <alias value="WoningType"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.value[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <example>
            <label value="Example of TypeofHome"/>
            <valueCodeableConcept>
              <coding>
                <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.13.1"/>
                <code value="FLATW"/>
                <display value="Appartement of flatwoning"/>
              </coding>
            </valueCodeableConcept>
          </example>
          <condition value="obs-7"/>
          <isSummary value="true"/>
          <binding>
            <strength value="extensible"/>
            <description value="Type of home the patient lives in."/>
            <valueSetReference>🔗
              <reference
                         value="http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.7.8.1--20171231000000"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map
                 value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)"/>
          </mapping>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 441742003 |Evaluation finding|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX.2, OBX.5, OBX.6"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="363714003 |Interprets|"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v1.2-2015EN"/>
            <map value="NL-CM:7.8.3"/>
            <comment value="TypeOfHome"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-3.0-2016EN"/>
            <map value="NL-CM:7.8.3"/>
            <comment value="TypeOfHome"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v3.1-2017EN"/>
            <map value="NL-CM:7.8.3"/>
            <comment value="HouseType"/>
          </mapping>
        </element>
        <element id="Observation.valueCodeableConcept:valueCodeableConcept.id">
          <path value="Observation.valueCodeableConcept.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element
                 id="Observation.valueCodeableConcept:valueCodeableConcept.extension">
          <path value="Observation.valueCodeableConcept.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element
                 id="Observation.valueCodeableConcept:valueCodeableConcept.coding">
          <path value="Observation.valueCodeableConcept.coding"/>
          <short value="Code defined by a terminology system"/>
          <definition
                      value="A reference to a code defined by a terminology system."/>
          <comment
                   value="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."/>
          <requirements
                        value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="CodeableConcept.coding"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.1-8, C*E.10-22"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="union(., ./translation)"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
          </mapping>
        </element>
        <element id="Observation.valueCodeableConcept:valueCodeableConcept.text">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="Observation.valueCodeableConcept.text"/>
          <short value="Plain text representation of the concept"/>
          <definition
                      value="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."/>
          <comment
                   value="Very often the text is the same as a displayName of one of the codings."/>
          <requirements
                        value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="CodeableConcept.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mustSupport value="true"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.9. But note many systems use C*E.2 for this"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/>
          </mapping>
        </element>
        <element id="Observation.dataAbsentReason">
          <path value="Observation.dataAbsentReason"/>
          <short value="Why the result is missing"/>
          <definition
                      value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
          <comment
                   value="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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   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 &quot;error&quot; 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 &gt; 0.  Because of these options, use-case agreements are required to interpret general observations for null or exceptional values."/>
          <requirements
                        value="For many results it is necessary to handle exceptional values in measurements."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.dataAbsentReason"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="obs-6"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationValueAbsentReason"/>
            </extension>
            <strength value="extensible"/>
            <description
                         value="Codes specifying why the result (Observation.value[x]) is missing."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map
                 value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="N/A"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value.nullFlavor"/>
          </mapping>
        </element>
        <element id="Observation.interpretation">
          <path value="Observation.interpretation"/>
          <short value="High, low, normal, etc."/>
          <definition
                      value="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."/>
          <requirements
                        value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
          <alias value="Abnormal Flag"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.interpretation"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationInterpretation"/>
            </extension>
            <strength value="extensible"/>
            <description
                         value="Codes identifying interpretations of observations."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 260245000 |Findings values|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-8"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="interpretationCode"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="363713009 |Has interpretation|"/>
          </mapping>
        </element>
        <element id="Observation.comment">
          <path value="Observation.comment"/>
          <short value="Comment"/>
          <definition
                      value="Comments in free text on problems or details of the patient’s living situation that may be relevant."/>
          <requirements
                        value="Need to be able to provide free text additional information."/>
          <alias value="Toelichting"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.comment"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mustSupport value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.note"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map
                 value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v1.2-2015EN"/>
            <map value="NL-CM:7.8.2"/>
            <comment value="Explanation"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-3.0-2016EN"/>
            <map value="NL-CM:7.8.2"/>
            <comment value="Explanation"/>
          </mapping>
          <mapping>
            <identity value="hcim-livingsituation-v3.1-2017EN"/>
            <map value="NL-CM:7.8.2"/>
            <comment value="Comment"/>
          </mapping>
        </element>
        <element id="Observation.bodySite">
          <path value="Observation.bodySite"/>
          <short value="Observed body part"/>
          <definition
                      value="Indicates the site on the subject's body where the observation was made (i.e. the target site)."/>
          <comment
                   value="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](http://hl7.org/fhir/STU3/extension-body-site-instance.html)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.bodySite"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="BodySite"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes describing anatomical locations. May include laterality."/>
            <valueSetReference>🔗
              <reference value="http://hl7.org/fhir/ValueSet/body-site"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 123037004 |Body structure|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-20"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="targetSiteCode"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="718497002 |Inherent location|"/>
          </mapping>
        </element>
        <element id="Observation.method">
          <path value="Observation.method"/>
          <short value="How it was done"/>
          <definition
                      value="Indicates the mechanism used to perform the observation."/>
          <comment
                   value="Only used if not implicit in code for Observation.code."/>
          <requirements
                        value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.method"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationMethod"/>
            </extension>
            <strength value="example"/>
            <description value="Methods for simple observations."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-methods"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-17"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="methodCode"/>
          </mapping>
        </element>
        <element id="Observation.specimen">
          <path value="Observation.specimen"/>
          <short value="Specimen used for this observation"/>
          <definition
                      value="The specimen that was used when this observation was made."/>
          <comment
                   value="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)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.specimen"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Specimen"/>
          </type>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 123038009 |Specimen|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="SPM segment"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="participation[typeCode=SPC].specimen"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="704319004 |Inherent in|"/>
          </mapping>
        </element>
        <element id="Observation.device">
          <path value="Observation.device"/>
          <short value="(Measurement) Device"/>
          <definition value="The device used to generate the observation data."/>
          <comment
                   value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.device"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Device"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DeviceMetric"/>
          </type>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 49062001 |Device|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-17 / PRT -10"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="participation[typeCode=DEV]"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="424226004 |Using device|"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange">
          <path value="Observation.referenceRange"/>
          <short value="Provides guide for interpretation"/>
          <definition
                      value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
          <comment
                   value="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."/>
          <requirements
                        value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.referenceRange"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() | (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="obs-3"/>
            <severity value="error"/>
            <human value="Must have at least a low or a high or text"/>
            <expression value="low.exists() or high.exists() or text.exists()"/>
            <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/>
            <source
                    value="http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation"/>
          </constraint>
          <mapping>
            <identity value="v2"/>
            <map value="OBX.7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.id">
          <path value="Observation.referenceRange.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.extension">
          <path value="Observation.referenceRange.extension"/>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.modifierExtension">
          <path value="Observation.referenceRange.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <isModifier value="true"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.low">
          <path value="Observation.referenceRange.low"/>
          <short value="Low Range, if relevant"/>
          <definition
                      value="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 &gt;=5 - &lt;=9).   If the low bound is omitted,  it is assumed to be meaningless (e.g. reference range is &lt;=2.3)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.referenceRange.low"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Quantity"/>
            <profile
                     value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
          </type>
          <condition value="obs-3"/>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value:IVL_PQ.low"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.high">
          <path value="Observation.referenceRange.high"/>
          <short value="High Range, if relevant"/>
          <definition
                      value="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 &gt;=5 - &lt;=9).   If the high bound is omitted,  it is assumed to be meaningless (e.g. reference range is &gt;= 2.3)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.referenceRange.high"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Quantity"/>
            <profile
                     value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
          </type>
          <condition value="obs-3"/>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value:IVL_PQ.high"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.type">
          <path value="Observation.referenceRange.type"/>
          <short value="Reference range qualifier"/>
          <definition
                      value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range."/>
          <comment
                   value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed."/>
          <requirements
                        value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc,  - for proper interpretation."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.referenceRange.type"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationRangeMeaning"/>
            </extension>
            <strength value="extensible"/>
            <description value="Code for the meaning of a reference range."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map
                 value="&lt; 260245000 |Findings values| OR
    &lt; 365860008 |General clinical state finding|
    OR
    &lt; 250171008 |Clinical history or observation findings| OR
    &lt; 415229000 |Racial group| OR
    &lt; 365400002 |Finding of puberty stage| OR
    &lt; 443938003 |Procedure carried out on subject|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-10"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="interpretationCode"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.appliesTo">
          <path value="Observation.referenceRange.appliesTo"/>
          <short value="Reference range population"/>
          <definition
                      value="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."/>
          <comment
                   value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed."/>
          <requirements
                        value="Need to be able to identify the target population for proper interpretation."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.referenceRange.appliesTo"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationRangeType"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes identifying the population the reference range applies to."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map
                 value="&lt; 260245000 |Findings values| OR
    &lt; 365860008 |General clinical state finding|
    OR
    &lt; 250171008 |Clinical history or observation findings| OR
    &lt; 415229000 |Racial group| OR
    &lt; 365400002 |Finding of puberty stage| OR
    &lt; 443938003 |Procedure carried out on subject|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-10"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="interpretationCode"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.age">
          <path value="Observation.referenceRange.age"/>
          <short value="Applicable age range, if relevant"/>
          <definition
                      value="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."/>
          <requirements value="Some analytes vary greatly over age."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.referenceRange.age"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Range"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map
                 value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
          </mapping>
        </element>
        <element id="Observation.referenceRange.text">
          <path value="Observation.referenceRange.text"/>
          <short value="Text based reference range in an observation"/>
          <definition
                      value="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 &quot;Negative&quot; or a list or table of 'normals'."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.referenceRange.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value:ST"/>
          </mapping>
        </element>
        <element id="Observation.related">
          <path value="Observation.related"/>
          <short value="Resource related to this observation"/>
          <definition
                      value="A  reference to another resource (usually another Observation) whose relationship is defined by the relationship type code."/>
          <comment
                   value="For a discussion on the ways Observations can assembled in groups together see [Notes below](http://hl7.org/fhir/STU3/observation.html#4.20.4)."/>
          <requirements
                        value="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."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.related"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() | (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="Relationships established by OBX-4 usage"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="outBoundRelationship"/>
          </mapping>
        </element>
        <element id="Observation.related.id">
          <path value="Observation.related.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.related.extension">
          <path value="Observation.related.extension"/>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.related.modifierExtension">
          <path value="Observation.related.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <isModifier value="true"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.related.type">
          <path value="Observation.related.type"/>
          <short
                 value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
          <definition
                      value="A code specifying the kind of relationship that exists with the target resource."/>
          <comment
                   value="The &quot;derived-from&quot; type is the only logical choice when referencing the QuestionnaireAnswer resource."/>
          <requirements value="A relationship type SHOULD be provided."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.related.type"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationRelationshipType"/>
            </extension>
            <strength value="required"/>
            <description
                         value="Codes specifying how two observations are related."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="v2"/>
            <map value="N/A"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".typeCode"/>
          </mapping>
        </element>
        <element id="Observation.related.target">
          <path value="Observation.related.target"/>
          <short value="Resource that is related to this one"/>
          <definition
                      value="A reference to the observation or [QuestionnaireResponse](http://hl7.org/fhir/STU3/questionnaireresponse.html#) resource that is related to this observation."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Observation.related.target"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Observation"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Sequence"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value=".targetObservation"/>
          </mapping>
        </element>
        <element id="Observation.component">
          <path value="Observation.component"/>
          <short value="Component results"/>
          <definition
                      value="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."/>
          <comment
                   value="For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7.org/fhir/STU3/observation.html#notes) below."/>
          <requirements
                        value="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."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.component"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() | (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="containment by OBX-4?"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="outBoundRelationship[typeCode=COMP]"/>
          </mapping>
        </element>
        <element id="Observation.component.id">
          <path value="Observation.component.id"/>
          <representation value="xmlAttr"/>
          <short value="xml:id (or equivalent in JSON)"/>
          <definition
                      value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.component.extension">
          <path value="Observation.component.extension"/>
          <short value="Additional Content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Observation.component.modifierExtension">
          <path value="Observation.component.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <isModifier value="true"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Observation.component.code">
          <path value="Observation.component.code"/>
          <short value="Type of component observation (code / type)"/>
          <definition
                      value="Describes what was observed. Sometimes this is called the observation &quot;code&quot;."/>
          <requirements
                        value="Knowing what kind of observation is being made is essential to understanding the observation."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Observation.component.code"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationCode"/>
            </extension>
            <strength value="example"/>
            <description value="Codes identifying names of simple observations."/>
            <valueSetReference>🔗
              <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map
                 value="&lt; 363787002 |Observable entity| OR
    &lt; 386053000 |Evaluation procedure|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-3"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="code"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="what"/>
          </mapping>
        </element>
        <element id="Observation.component.value[x]">
          <path value="Observation.component.value[x]"/>
          <short value="Actual component result"/>
          <definition
                      value="The information determined as a result of making the observation, if the information has a simple value."/>
          <comment
                   value="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 &lt;http://hl7.org/fhir/ValueSet/v2-0136&gt; (these &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot; or other mutually exclusive terms that may be needed&quot;).  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 &quot;'value' + the type name&quot; with a capital on the first letter of the type)."/>
          <requirements
                        value="An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.component.value[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Quantity"/>
          </type>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <type>
            <code value="string"/>
          </type>
          <type>
            <code value="Range"/>
          </type>
          <type>
            <code value="Ratio"/>
          </type>
          <type>
            <code value="SampledData"/>
          </type>
          <type>
            <code value="Attachment"/>
          </type>
          <type>
            <code value="time"/>
          </type>
          <type>
            <code value="dateTime"/>
          </type>
          <type>
            <code value="Period"/>
          </type>
          <isSummary value="true"/>
          <mapping>
            <identity value="sct-concept"/>
            <map
                 value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX.2, OBX.5, OBX.6"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="363714003 |Interprets|"/>
          </mapping>
        </element>
        <element id="Observation.component.dataAbsentReason">
          <path value="Observation.component.dataAbsentReason"/>
          <short value="Why the component result is missing"/>
          <definition
                      value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
          <comment
                   value="&quot;Null&quot; 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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;.   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 &quot;error&quot; 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."/>
          <requirements
                        value="For many results it is necessary to handle exceptional values in measurements."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.component.dataAbsentReason"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="obs-6"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationValueAbsentReason"/>
            </extension>
            <strength value="extensible"/>
            <description
                         value="Codes specifying why the result (Observation.value[x]) is missing."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="v2"/>
            <map value="N/A"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="value.nullFlavor"/>
          </mapping>
        </element>
        <element id="Observation.component.interpretation">
          <path value="Observation.component.interpretation"/>
          <short value="High, low, normal, etc."/>
          <definition
                      value="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."/>
          <comment
                   value="The component interpretation applies only to the individual component value.  For an overall interpretation all components together use thes Observation.interpretation element."/>
          <requirements
                        value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
          <alias value="Abnormal Flag"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Observation.component.interpretation"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="ObservationInterpretation"/>
            </extension>
            <strength value="extensible"/>
            <description
                         value="Codes identifying interpretations of observations."/>
            <valueSetReference>🔗
              <reference
                         value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
            </valueSetReference>
          </binding>
          <mapping>
            <identity value="sct-concept"/>
            <map value="&lt; 260245000 |Findings values|"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="OBX-8"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="interpretationCode"/>
          </mapping>
          <mapping>
            <identity value="sct-attr"/>
            <map value="363713009 |Has interpretation|"/>
          </mapping>
        </element>
        <element id="Observation.component.referenceRange">
          <path value="Observation.component.referenceRange"/>
          <short value="Provides guide for interpretation of component result"/>
          <definition
                      value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
          <comment
                   value="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."/>
          <requirements
                        value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Observation.component.referenceRange"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <contentReference
                            value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange"/>
          <mapping>
            <identity value="v2"/>
            <map value="OBX.7"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
          </mapping>
        </element>
      </snapshot>
      <differential>
        <element id="Observation">
          <path value="Observation"/>
        </element>
        <element id="Observation.valueCodeableConcept.text">
          <path value="Observation.valueCodeableConcept.text"/>
          <mustSupport value="true"/>
        </element>
        <element id="Observation.comment">
          <path value="Observation.comment"/>
          <mustSupport value="true"/>
        </element>
      </differential>
    </StructureDefinition>