Introduction

This profile is used to represent de-identified Income information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Income Observation resource text element may contain Patient information such as names. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original Observation resource id should not be included in the De-identified Observation instance. Instead a new id should be created and provided as part of the FHIR resource. This Data Submitter should be capable of using the generated id to relink the data to the original Income Observation. All resource references to the Income Observation submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

• subject

Representing Income Ranges

Income ranges are represented using the Observation.valueRange or Observation.valueQuanity element. The following values can be used to represent the Income ranges:

* 100% and below : use valueRange.high to represent 100% (Includes 100)
* 101–150% : use valueRange.low to represent 101, valueRange.high to represent 150 (Includes 101 and 150)
* 151–200% : use valueRange.low to represent 151, valueRange.high to represent 200 (Includes 151 and 200)
* Over 200% : use valueQuantity.value to represent 200, units of % and comparator of ">", valueRange cannot be used for representing more than 200%.
* For unknown use the dataAbsentReason

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

• effectiveDateTime.

Examples

Examples of identifiable data and its corresponding de-identifiable data is present in Reporting Guidance.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	De-Identified UDS Plus Income Constraints: obs-6, obs-7
Observation.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.Slices for extension				Content/Rules for all slices
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
Observation.code.id		0..1	string	Unique id for inter-element referencing
Observation.code.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.id		0..1	string	Unique id for inter-element referencing
Observation.code.coding.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.version		0..1	string	Version of the system - if relevant
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.code.coding.display		0..1	string	Representation defined by the system
Observation.code.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Observation.code.text		0..1	string	Plain text representation of the concept
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.Slices for extension				Content/Rules for all slices
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	Observation	De-Identified UDS Plus Income
Observation.id	S This element must be supported.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.text		0..0		Cannot include any text in the resource as part of the de-identified data.
Observation.contained		0..0		Cannot include any contained resources in the resource as part of the de-identified data.
Observation.Slices for extension				Content/Rules for all slices
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.status	S This element must be supported.	1..1	code	registered | preliminary | final | amended + Fixed Value: final
Observation.code	S This element must be supported.	1..1	CodeableConcept	Type of observation (code / type) Required Pattern: At least the following
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.subject	S This element must be supported.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.subject.display		0..0		Text alternative for the resource
Observation.encounter
Observation.encounter.display		0..0		Text alternative for the resource
Observation.effective[x]	S This element must be supported. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.issued	S This element must be supported.	0..0		Date/Time this version was made available
Observation.performer
Observation.performer.display		0..0		Text alternative for the resource
Observation.value[x]	S This element must be supported. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.Slices for extension				Content/Rules for all slices
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Observation.note		0..0		Comments about the observation
Observation.bodySite		0..0		Observed body part
Observation.specimen		0..0		Specimen used for this observation
Observation.device		0..0		(Measurement) Device
Observation.hasMember		0..0		Related resource that belongs to the Observation group
Observation.derivedFrom		0..0		Related measurements the observation is made from
Observation.component		0..0		Component results
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	De-Identified UDS Plus Income Constraints: obs-6, obs-7
Observation.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Observation.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for observation
Observation.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
Observation.partOf	Σ This element is included in summaries.	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Observation.category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
Observation.code.id		0..1	string	Unique id for inter-element referencing
Observation.code.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.id		0..1	string	Unique id for inter-element referencing
Observation.code.coding.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.version		0..1	string	Version of the system - if relevant
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.code.coding.display		0..1	string	Representation defined by the system
Observation.code.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Observation.code.text		0..1	string	Plain text representation of the concept
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.subject.id		0..1	string	Unique id for inter-element referencing
Observation.subject.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.subject.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.subject.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.subject.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.focus	Σ This element is included in summaries.	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
Observation.encounter	Σ This element is included in summaries.	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Observation.encounter.id		0..1	string	Unique id for inter-element referencing
Observation.encounter.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.encounter.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.encounter.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.encounter.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.performer	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
Observation.performer.id		0..1	string	Unique id for inter-element referencing
Observation.performer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.performer.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.performer.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.performer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.id		0..1	string	Unique id for inter-element referencing
Observation.value[x].value[x]All Types.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Observation.dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
Observation.referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
Observation.referenceRange.id		0..1	string	Unique id for inter-element referencing
Observation.referenceRange.extension		0..*	Extension	Additional content defined by implementations
Observation.referenceRange.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant Constraints: sqty-1
Observation.referenceRange.high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant Constraints: sqty-1
Observation.referenceRange.type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age		0..1	Range	Applicable age range, if relevant
Observation.referenceRange.text		0..1	string	Text based reference range in an observation
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.subject.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.encounter.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.performer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
sqty-1	error	Observation.referenceRange.low, Observation.referenceRange.high	The comparator is not used on a SimpleQuantity	comparator.empty()
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	De-Identified UDS Plus Income Constraints: obs-6, obs-7
Observation.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.Slices for extension				Content/Rules for all slices
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
Observation.code.id		0..1	string	Unique id for inter-element referencing
Observation.code.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.id		0..1	string	Unique id for inter-element referencing
Observation.code.coding.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.version		0..1	string	Version of the system - if relevant
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.code.coding.display		0..1	string	Representation defined by the system
Observation.code.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Observation.code.text		0..1	string	Plain text representation of the concept
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.Slices for extension				Content/Rules for all slices
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation		0..*	Observation	De-Identified UDS Plus Income
Observation.id	S This element must be supported.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.text		0..0		Cannot include any text in the resource as part of the de-identified data.
Observation.contained		0..0		Cannot include any contained resources in the resource as part of the de-identified data.
Observation.Slices for extension				Content/Rules for all slices
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.status	S This element must be supported.	1..1	code	registered | preliminary | final | amended + Fixed Value: final
Observation.code	S This element must be supported.	1..1	CodeableConcept	Type of observation (code / type) Required Pattern: At least the following
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.subject	S This element must be supported.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.subject.display		0..0		Text alternative for the resource
Observation.encounter
Observation.encounter.display		0..0		Text alternative for the resource
Observation.effective[x]	S This element must be supported. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.issued	S This element must be supported.	0..0		Date/Time this version was made available
Observation.performer
Observation.performer.display		0..0		Text alternative for the resource
Observation.value[x]	S This element must be supported. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.Slices for extension				Content/Rules for all slices
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Observation.note		0..0		Comments about the observation
Observation.bodySite		0..0		Observed body part
Observation.specimen		0..0		Specimen used for this observation
Observation.device		0..0		(Measurement) Device
Observation.hasMember		0..0		Related resource that belongs to the Observation group
Observation.derivedFrom		0..0		Related measurements the observation is made from
Observation.component		0..0		Component results
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Observation	C	0..*	Observation	De-Identified UDS Plus Income Constraints: obs-6, obs-7
Observation.id	S This element must be supported. Σ This element is included in summaries.	0..1	id	The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver
Observation.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Observation.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Observation.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Observation.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Observation.Slices for extension.extension:deidentifiedIssuedTime		0..1	dateTime	Indicates the time with a precision of only Year. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
Observation.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Observation.identifier	Σ This element is included in summaries.	0..*	Identifier	Business Identifier for observation
Observation.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
Observation.partOf	Σ This element is included in summaries.	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
Observation.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Observation.category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
Observation.code	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
Observation.code.id		0..1	string	Unique id for inter-element referencing
Observation.code.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
Observation.code.coding.id		0..1	string	Unique id for inter-element referencing
Observation.code.coding.extension		0..*	Extension	Additional content defined by implementations
Observation.code.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
Observation.code.coding.version		0..1	string	Version of the system - if relevant
Observation.code.coding.code		1..1	code	Symbol in syntax defined by the system Fixed Value: 63058-2
Observation.code.coding.display		0..1	string	Representation defined by the system
Observation.code.coding.userSelected		0..1	boolean	If this coding was chosen directly by the user
Observation.code.text		0..1	string	Plain text representation of the concept
Observation.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(De-Identified UDS Plus Patient)	Who and/or what the observation is about
Observation.subject.id		0..1	string	Unique id for inter-element referencing
Observation.subject.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.subject.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.subject.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.subject.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.focus	Σ This element is included in summaries.	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
Observation.encounter	Σ This element is included in summaries.	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Observation.encounter.id		0..1	string	Unique id for inter-element referencing
Observation.encounter.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.encounter.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.encounter.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.encounter.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.effective[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Clinically relevant time/time-period for observation Constraints: uds-plus-inc-1, uds-plus-inc-1a, uds-plus-inc-1b, uds-plus-inc-2, uds-plus-inc-2a, uds-plus-inc-2b, uds-plus-inc-3, uds-plus-inc-3a, uds-plus-inc-3b, uds-plus-inc-4, uds-plus-inc-5, uds-plus-res-5a, uds-plus-res-5b
Observation.effective[x].effectiveDateTime			dateTime S This target must be supported.
Observation.effective[x].effectivePeriod			Period
Observation.effective[x].effectiveTiming			Timing
Observation.performer	Σ This element is included in summaries.	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation
Observation.performer.id		0..1	string	Unique id for inter-element referencing
Observation.performer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.performer.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Observation.performer.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Observation.performer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Observation.value[x]	S This element must be supported. Σ This element is included in summaries. C	0..1		Actual result Constraints: uds-plus-inc-6, uds-plus-inc-7, uds-plus-inc-8
Observation.value[x].value[x]All Types				Content/Rules for all Types
Observation.value[x].value[x]All Types.id		0..1	string	Unique id for inter-element referencing
Observation.value[x].value[x]All Types.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Observation.value[x].value[x]All Types.Slices for extension.extension:dataAbsentReason	S This element must be supported.	0..1	code	Reason why the data is not present URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.
Observation.value[x].valueRange			Range
Observation.value[x].valueQuantity			Quantity
Observation.dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Observation.interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
Observation.method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
Observation.referenceRange	C	0..*	BackboneElement	Provides guide for interpretation Constraints: obs-3
Observation.referenceRange.id		0..1	string	Unique id for inter-element referencing
Observation.referenceRange.extension		0..*	Extension	Additional content defined by implementations
Observation.referenceRange.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Observation.referenceRange.low	C	0..1	SimpleQuantity(4.0.1)	Low Range, if relevant Constraints: sqty-1
Observation.referenceRange.high	C	0..1	SimpleQuantity(4.0.1)	High Range, if relevant Constraints: sqty-1
Observation.referenceRange.type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
Observation.referenceRange.appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
Observation.referenceRange.age		0..1	Range	Applicable age range, if relevant
Observation.referenceRange.text		0..1	string	Text based reference range in an observation
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Observation.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Observation.status	Base	required	ObservationStatus	📍4.0.1	FHIR Std.
Observation.category	Base	preferred	Observation Category Codes	📍4.0.1	FHIR Std.
Observation.code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.subject.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.encounter.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.performer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Observation.dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.
Observation.method	Base	example	Observation Methods	📍4.0.1	FHIR Std.
Observation.referenceRange.​type	Base	preferred	Observation Reference Range Meaning Codes	📍4.0.1	FHIR Std.
Observation.referenceRange.​appliesTo	Base	example	Observation Reference Range Applies To Codes	📍4.0.1	FHIR Std.
Observation.component.​code	Base	example	LOINC Codes	📍4.0.1	FHIR Std.
Observation.component.​dataAbsentReason	Base	extensible	DataAbsentReason	📍4.0.1	FHIR Std.
Observation.component.​interpretation	Base	extensible	Observation Interpretation Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text	low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present	dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present	value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
sqty-1	error	Observation.referenceRange.low, Observation.referenceRange.high	The comparator is not used on a SimpleQuantity	comparator.empty()
uds-plus-inc-1	error	Observation.effective[x]	All dateTime data elements should be truncated to a year only for de-identified resources.	$this is DateTime implies $this.toString().length() = 4
uds-plus-inc-1a	error	Observation.effective[x]	All dateTime data elements should have valid year > 1900	$this is DateTime implies $this.toString() >= '1900'
uds-plus-inc-1b	error	Observation.effective[x]	All dateTime data elements should have valid year < 2030	$this is DateTime implies $this.toString() <= '2030'
uds-plus-inc-2	error	Observation.effective[x]	All Period.start data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-inc-2a	error	Observation.effective[x]	All Period.start data elements should have valid year > 1900	$this is Period and Period.start.exists() implies $this.start.toString() >= '1900'
uds-plus-inc-2b	error	Observation.effective[x]	All Period.start data elements should have valid year < 2030	$this is Period and Period.start.exists() implies $this.start.toString() <= '2030'
uds-plus-inc-3	error	Observation.effective[x]	All Period.emd data elements should be truncated to a year only for de-identified resources.	$this is Period and Period.end.exists() implies $this.end.toString().length() = 4
uds-plus-inc-3a	error	Observation.effective[x]	All Period.end data elements should have valid year > 1900	$this is Period and Period.end.exists() implies $this.end.toString() >= '1900'
uds-plus-inc-3b	error	Observation.effective[x]	All Period.end data elements should have valid year < 2030	$this is Period and Period.end.exists() implies $this.end.toString() <= '2030'
uds-plus-inc-4	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.count() = 1
uds-plus-inc-5	error	Observation.effective[x]	All Timing.event data elements should be truncated to a year only for de-identified resources.	$this is Timing and Timing.event.exists() implies $this.event.first().toString().length() = 4
uds-plus-inc-6	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements to be between 101% and 150% or between 151% and 200%	$this is Range and Range.low.exists() and Range.high.exists() implies ((Range.low.value >= 101 and Range.high.value <= 150) or (Range.low.value >= 151 and Range.high.value <= 200))
uds-plus-inc-7	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when less than 100%	$this is Range and Range.low.exists().not() and Range.high.exists() implies (Range.high.value <= 100)
uds-plus-inc-8	error	Observation.value[x]	Income Ranges should be coded according to the UDS+ requirements when more than 200%, Quantity should include value(200), code(%) and comparator(>)	$this is Quantity implies ($this.value >= 200 and $this.code = '%' and $this.comparator = '>')
uds-plus-res-5a	error	Observation.effective[x]	All Timing data elements should have valid year > 1900	$this is Timing and Timing.event.exists() implies $this.event.first().toString() >= '1900'
uds-plus-res-5b	error	Observation.effective[x]	All Timing data elements should have valid year < 2030	$this is Timing and Timing.event.exists() implies $this.event.first().toString() <= '2030'

This structure is derived from Observation

Summary

Mandatory: 3 elements
Must-Support: 8 elements
Fixed: 1 element
Prohibited: 13 elements

Structures

This structure refers to these other structures:

• De-Identified UDS Plus Patient (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-patient)

Extensions

This structure refers to these extensions:

• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-deidentified-instant-extension
• http://hl7.org/fhir/StructureDefinition/data-absent-reason|4.0.1

Maturity: 2