Generated Narrative: StructureDefinition be-childreport Name Flags Card. Type Description & Constraints Bundle 0..* BeDocument Contains a collection of resources #xD; identifier 1..1 Identifier Persistent identifier for the Bundle #xD; type 1..1 code document #xD; timestamp 1..1 instant The time when the document was created #xD; Slices for entry 3..* BackboneElement Entry resource in the child report bundle Slice: Ordered, Open by value:resource #xD; entry:All Slices Content/Rules for all slices #xD; fullUrl S 1..1 uri URI for resource (Absolute URL server address or URI for UUID/OID) #xD; entry:composition S 1..1 BackboneElement The Child Report Composition #xD; resource 1..1 BeChildReportComposition The Composition for the child report #xD; entry:patient S 1..1 BackboneElement The child (patient) #xD; resource 1..1 BePatient The child #xD; entry:relatedPerson S 1..1 BackboneElement The mother or guardian #xD; resource 1..1 RelatedPerson The mother or guardian #xD; entry:pregnancyDuration S 0..1 BackboneElement Duration of the pregnancy in weeks #xD; resource 1..1 BeClinicalObservation Observation for pregnancy duration in weeks #xD; code 1..1 CodeableConcept Length of gestation at birth Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 412726003 #xD; display 1..1 string Representation defined by the system Fixed Value: Length of gestation at birth #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; focus S 0..* Reference(RelatedPerson) The mother (RelatedPerson) #xD; value[x] 0..1 Quantity Duration in weeks #xD; unit 0..1 string Unit representation Required Pattern: weeks #xD; code 0..1 code Coded form of the unit Required Pattern: wk #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:pregnancyCMVInfection S 0..1 BackboneElement Whether CMV infection occurred during pregnancy #xD; resource 1..1 BeClinicalObservation Observation for CMV infection during pregnancy (focus: the mother) #xD; code 1..1 CodeableConcept CMV infection Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 28944009 #xD; display 1..1 string Representation defined by the system Fixed Value: CMV - Cytomegalovirus infection #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; focus S 1..1 Reference(RelatedPerson) The mother (RelatedPerson) #xD; value[x] 0..1 boolean Whether CMV infection was present #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:pregnancyBacterialMeningitis S 0..1 BackboneElement Whether bacterial meningitis occurred #xD; resource 1..1 BeClinicalObservation Observation for bacterial meningitis #xD; code 1..1 CodeableConcept Bacterial meningitis Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 95883001 #xD; display 1..1 string Representation defined by the system Fixed Value: Bacterial meningitis #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; focus S 0..* Reference(RelatedPerson) The mother (RelatedPerson) #xD; value[x] 0..1 boolean Whether bacterial meningitis was present #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:neonatalHearingScreening S 0..* BackboneElement Overall neonatal hearing screening result #xD; resource 1..1 BeClinicalObservation Observation for overall neonatal hearing screening #xD; code 1..1 CodeableConcept Hearing screening test code Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 102972004 #xD; display 1..1 string Representation defined by the system Fixed Value: Brain stem auditory evoked potential, function #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; effective[x] 1..1 dateTime Clinically relevant time/time-period for observation #xD; value[x] 1..1 CodeableConcept normal result | abnormal result | invalid result | test not done Binding: Neonatal Hearing Screening Results (required) #xD; component 0..0 Component results #xD; entry:neonatalHearingScreeningLeft S 0..1 BackboneElement Hearing screening result for the left ear #xD; resource 1..1 BeClinicalObservation Observation for hearing screening - left ear #xD; code 1..1 CodeableConcept Hearing screening test code Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 102972004 #xD; display 1..1 string Representation defined by the system Fixed Value: Brain stem auditory evoked potential, function #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; effective[x] 1..1 dateTime Clinically relevant time/time-period for observation #xD; value[x] 1..1 CodeableConcept normal result | abnormal result | invalid result | test not done Binding: Neonatal Hearing Screening Results (required) #xD; bodySite 0..1 CodeableConcept Left ear Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 117590005 #xD; display 1..1 string Representation defined by the system Fixed Value: Ear structure #xD; extension 1..* Extension Extension #xD; Slices for extension Content/Rules for all slices #xD; extension:laterality 1..1 BeExtLaterality BeExtLaterality #xD; value[x] 0..1 Coding Value of extension Required Pattern: At least the following #xD; component 0..0 Component results #xD; entry:neonatalHearingScreeningRight S 0..1 BackboneElement Hearing screening result for the right ear #xD; resource 1..1 BeClinicalObservation Observation for hearing screening - right ear #xD; code 1..1 CodeableConcept Hearing screening test code Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 102972004 #xD; display 1..1 string Representation defined by the system Fixed Value: Brain stem auditory evoked potential, function #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; effective[x] 1..1 dateTime Clinically relevant time/time-period for observation #xD; value[x] 1..1 CodeableConcept normal result | abnormal result | invalid result | test not done Binding: Neonatal Hearing Screening Results (required) #xD; bodySite 0..1 CodeableConcept Right ear Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 117590005 #xD; display 1..1 string Representation defined by the system Fixed Value: Ear structure #xD; extension 1..* Extension Extension #xD; Slices for extension Content/Rules for all slices #xD; extension:laterality 1..1 BeExtLaterality BeExtLaterality #xD; value[x] 0..1 Coding Value of extension Required Pattern: At least the following #xD; component 0..0 Component results #xD; entry:severeHeadTrauma S 0..1 BackboneElement Whether severe head trauma occurred during delivery #xD; resource 1..1 BeClinicalObservation Observation for severe head trauma during delivery #xD; code 1..1 CodeableConcept Intracranial injury Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 127296001 #xD; display 1..1 string Representation defined by the system Fixed Value: Intracranial injury #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 boolean Whether severe head trauma was present #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:eyeScreening S 0..* BackboneElement Eye screening result #xD; resource 1..1 BeClinicalObservation Observation for eye screening result #xD; code 1..1 CodeableConcept Eye/vision screening Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 363926002 #xD; display 1..1 string Representation defined by the system Fixed Value: Eye/vision observable #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 CodeableConcept normal result | abnormal result | invalid result | test not done Binding: Eye Screening Results (required) #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:inspectionPupilAbnormal S 0..1 BackboneElement Whether pupil inspection was abnormal #xD; resource 1..1 BeClinicalObservation Observation for abnormal pupil inspection #xD; code 1..1 CodeableConcept Abnormal pupil finding Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 274093008 #xD; display 1..1 string Representation defined by the system Fixed Value: Abnormal pupil #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 boolean Whether pupil abnormality was found #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:eyeMovementAndPositionLeft S 0..* BackboneElement Eye movement and position finding - left eye #xD; resource 1..1 BeClinicalObservation Observation for eye movement and position - left eye #xD; code 1..1 CodeableConcept Ocular motility Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 31763002 #xD; display 1..1 string Representation defined by the system Fixed Value: Ocular motility observable #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 CodeableConcept intermittent strabismus | continuous strabismus | nystagmus present Binding: Eye Movement and Position (required) #xD; bodySite 0..1 CodeableConcept Left eye Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 81745001 #xD; display 1..1 string Representation defined by the system Fixed Value: Structure of eye proper #xD; extension 1..* Extension Extension #xD; Slices for extension Content/Rules for all slices #xD; extension:laterality 1..1 BeExtLaterality BeExtLaterality #xD; value[x] 0..1 Coding Value of extension Required Pattern: At least the following #xD; component 0..0 Component results #xD; entry:eyeMovementAndPositionRight S 0..* BackboneElement Eye movement and position finding - right eye #xD; resource 1..1 BeClinicalObservation Observation for eye movement and position - right eye #xD; code 1..1 CodeableConcept Ocular motility Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 31763002 #xD; display 1..1 string Representation defined by the system Fixed Value: Ocular motility observable #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 CodeableConcept intermittent strabismus | continuous strabismus | nystagmus present Binding: Eye Movement and Position (required) #xD; bodySite 0..1 CodeableConcept Right eye Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: 81745001 #xD; display 1..1 string Representation defined by the system Fixed Value: Structure of eye proper #xD; extension 1..* Extension Extension #xD; Slices for extension Content/Rules for all slices #xD; extension:laterality 1..1 BeExtLaterality BeExtLaterality #xD; value[x] 0..1 Coding Value of extension Required Pattern: At least the following #xD; component 0..0 Component results #xD; entry:eyeRemarks S 0..1 BackboneElement Free text remarks about the eyes #xD; resource 1..1 BeClinicalObservation Observation for free text eye remarks #xD; code 1..1 CodeableConcept Eye remarks Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/cs-child-report-documentation #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: eye-remarks-observation #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 string Free text eye remarks #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; entry:inTreatmentWithOphthalmologist S 0..* BackboneElement Treatment the patient has followed with an ophthalmologist #xD; resource 1..1 BeClinicalObservation Observation for treatment with an ophthalmologist #xD; code 1..1 CodeableConcept In treatment with ophthalmologist Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/cs-child-report-documentation #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: ophthalmologist-treatment-observation #xD; subject 1..1 Reference(BePatient) The child that is the subject of this document #xD; value[x] 0..1 CodeableConcept prescription of spectacles | application of eye patch | surgical procedure on eye proper | (extensible) Binding: Ophthalmologist Treatments (extensible) #xD; bodySite 0..0 Observed body part #xD; component 0..0 Component results #xD; Documentation for this format
Profile for the child report document - a Bundle of type 'document' that contains a Composition resource and other related resources with information about the child and the pregnancy. This profile is used for the exchange of information about the child, to be first implemented in Flanders.
A container for a collection of resources.
total.empty() or (type = 'searchset') or (type = 'history')
not(f:total) or (f:type/@value = 'searchset') or (f:type/@value = 'history')
entry.search.empty() or (type = 'searchset')
not(f:entry/f:search) or (f:type/@value = 'searchset')
entry.request mandatory for batch/transaction/history, otherwise prohibited
entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
not(f:entry/f:request) or (f:type/@value = 'batch') or (f:type/@value = 'transaction') or (f:type/@value = 'history')
entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
not(f:entry/f:response) or (f:type/@value = 'batch-response') or (f:type/@value = 'transaction-response') or (f:type/@value = 'history')
FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
(type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
(f:type/@value = 'history') or (count(for $entry in f:entry[f:resource] return $entry[count(parent::f:Bundle/f:entry[f:fullUrl/@value=$entry/f:fullUrl/@value and ((not(f:resource/*/f:meta/f:versionId/@value) and not($entry/f:resource/*/f:meta/f:versionId/@value)) or f:resource/*/f:meta/f:versionId/@value=$entry/f:resource/*/f:meta/f:versionId/@value)])!=1])=0)
A document must have an identifier with a system and a value
type = 'document' implies (identifier.system.exists() and identifier.value.exists())
not(f:type/@value = 'document') or exists(f:identifier/f:system) or exists(f:identifier/f:value)
type = 'document' implies (timestamp.hasValue())
not(f:type/@value = 'document') or exists(f:timestamp/@value)
A document must have a Composition as the first resource
type = 'document' implies entry.first().resource.is(Composition)
not(f:type/@value='document') or f:entry[1]/f:resource/f:Composition
A message must have a MessageHeader as the first resource
type = 'message' implies entry.first().resource.is(MessageHeader)
not(f:type/@value='message') or f:entry[1]/f:resource/f:MessageHeader
ClinicalDocument, if bundle.type = document
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
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).
A persistent identifier for the bundle that won't change as a bundle is copied from server to server.
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
Indicates the purpose of this bundle - how it is intended to be used.
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
Indicates the purpose of a bundle - how it is intended to be used.
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated. Usage: * document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time * message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message * history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates * searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query * transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
A series of links that provide context to this bundle.
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. [HATEOAS](http://en.wikipedia.org/wiki/HATEOAS)). Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was [read](http://hl7.org/fhir/R4/http.html#read) directly. This specification defines some specific uses of Bundle.link for [searching](http://hl7.org/fhir/R4/search.html#conformance) and [paging](http://hl7.org/fhir/R4/http.html#paging), but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Extensions that cannot be ignored even if unrecognized
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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
See http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1
A name which details the functional use for this link - see [http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1](http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1).
Entry resource in the child report bundle
An entry resource included in the child report document bundle resource.
Must contain the Composition as the first entry (only a single Composition resource instance may be included) and a Patient resource.
For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
must be a resource unless there's a request or response
resource.exists() or request.exists() or response.exists()
exists(f:resource) or exists(f:request) or exists(f:response)
fullUrl cannot be a version specific reference
not(exists(f:fullUrl[contains(string(@value), '/_history/')]))
A series of links that provide context to this entry.
URI for resource (Absolute URL server address or URI for UUID/OID)
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that: * fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle) * Results from operations might involve resources that are not identified.
fullUrl might not be [unique in the context of a resource](http://hl7.org/fhir/R4/bundle.html#bundle-unique). Note that since [FHIR resources do not need to be served through the FHIR API](http://hl7.org/fhir/R4/references.html), the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the [regex](http://hl7.org/fhir/R4/references.html#regex), then the 'id' portion of the fullUrl SHALL end with the Resource.id. Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Information about the search process that lead to the creation of this entry.
match | include | outcome - why this is in the result set
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
When searching, the server's search ranking score for the entry.
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order. See [Patient Match](http://hl7.org/fhir/R4/patient-operation-match.html) for the EMPI search which relates to this element.
Additional execution information (transaction/batch/history)
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
GET | HEAD | POST | PUT | DELETE | PATCH
In a transaction or batch, this is the HTTP action to be executed for this entry. In a history bundle, this indicates the HTTP action that occurred.
HTTP verbs (in the HTTP command line). See [HTTP rfc](https://tools.ietf.org/html/rfc7231) for details.
The URL for this entry, relative to the root (the address to which the request is posted).
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
If the ETag values match, return a 304 Not Modified status. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4/http.html#cread).
Only perform the operation if the last updated date matches. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4/http.html#cread).
Only perform the operation if the Etag value matches. For more information, see the API section ["Managing Resource Contention"](http://hl7.org/fhir/R4/http.html#concurrency).
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for ["Conditional Create"](http://hl7.org/fhir/R4/http.html#ccreate). This is just the query portion of the URL - what follows the "?" (not including the "?").
Results of execution (transaction/batch/history)
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
The location (if the operation returns a location)
The location header created by processing this operation, populated if the operation returns a location.
The Etag for the resource, if the operation for the entry produced a versioned resource (see [Resource Metadata and Versioning](http://hl7.org/fhir/R4/http.html#versioning) and [Managing Resource Contention](http://hl7.org/fhir/R4/http.html#concurrency)).
Etags match the Resource.meta.versionId. The ETag has to match the version id in the header if a resource is included.
The date/time that the resource was modified on the server.
This has to match the same time in the meta header (meta.lastUpdated) if a resource is included.
OperationOutcome with hints and warnings (for batch/transaction)
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned. This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
An entry in a bundle resource - will either contain a resource or information about a resource (transactions and history only).
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Observation for pregnancy duration in weeks
Measurements and simple assertions made about a patient, device or other subject.
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 laboratory reports, etc.
Observation[classCode=OBS, moodCode=EVN]
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
A unique identifier assigned to this observation.
Allows observations to be distinguished and referenced.
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.
A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.
To link an Observation to an Encounter use `encounter`. See the [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below for guidance on referencing another Observation.
registered | preliminary | final | amended +
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Need to track the status of individual results. Some results are finalized before the whole report is finalized.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Codes providing the status of an observation.
status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
A code that classifies the general type of observation being made.
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.
Used for filtering what observations are retrieved and displayed.
Codes for high level observation categories.
.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Describes what was observed. Sometimes this is called the observation "name". For providing systems, it is RECOMMENDED to express this using a code and consuming software SHALL record this. In general, it shall be noted SNOMED-CT is the preferred national terminology. Other coding systems remain allowed or MAY be preferred in specific flows (e.g. the use of LOINC codes to express a laboratory test.)
*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
Knowing what kind of observation is being made is essential to understanding the observation.
Codes identifying names of simple observations.
< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
The child that is the subject of this document
The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.
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.
Observations have no value if you don't know who or what they're about.
The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](http://hl7.org/fhir/R4/extension-observation-focuscode.html).
Healthcare event during which this observation is made
The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
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 but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
For some observations it may be important to know the link between an observation and a particular encounter.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Clinically relevant time/time-period for observation
The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the [Timing](http://hl7.org/fhir/R4/datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
Date/Time this version was made available
The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](http://hl7.org/fhir/R4/resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.
OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
Who was responsible for asserting the observed value as "true".
When the specific performer is not known, the organisation can be used. When a device is creating the entry, `.device` should identify the device, and `.performer` should identify the person responsible for (using) the device, e.g. the professional or patient. In cases where the performer is known but there is no resource or unique identifier, the reference.display can be used - although this should be avoided.
May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
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'
The information determined as a result of making the observation, if the information has a simple value.
An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. 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 additional guidance, see the [Notes section](http://hl7.org/fhir/R4/observation.html#notes) below.
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Extensions are always sliced by (at least) url
Numerical value (with implicit precision)
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
< | <= | >= | > - how to understand the value
How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
A computer processable form of the unit in some unit representation system.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
PQ.code, MO.currency, PQ.translation.code
Provides a reason why the expected value in the element Observation.value[x] is missing.
Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
For many results it is necessary to handle exceptional values in measurements.
Codes specifying why the result (`Observation.value[x]`) is missing.
A categorical assessment of an observation value. For example, high, low, normal.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Codes identifying interpretations of observations.
Comments about the observation or the results.
May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Need to be able to provide free text additional information.
NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
Indicates the site on the subject's body where the observation was made (i.e. the target site).
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[ bodySite](http://hl7.org/fhir/R4/extension-bodysite.html).
Codes describing anatomical locations. May include laterality.
Specifies the laterality of the body where the procedure was performed if this precision is not contained in the code (right, left, both).
Describes the location or relative position of the procedure on the body, such as superior/inferior, medial/lateral or internal/external.
A reference to a code defined by a terminology system.
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.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
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.
Very often the text is the same as a displayName of one of the codings.
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.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Indicates the mechanism used to perform the observation.
Only used if not implicit in code for Observation.code.
In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
The specimen that was used when this observation was made.
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).
The device used to generate the observation data.
Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.
Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.
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 might 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.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Must have at least a low or a high or text
low.exists() or high.exists() or text.exists()
(exists(f:low) or exists(f:high)or exists(f:text))
outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.
Code for the meaning of a reference range.
< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
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. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Need to be able to identify the target population for proper interpretation.
Codes identifying the population the reference range applies to.
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.
Text based reference range in an observation
Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
Related resource that belongs to the Observation group
This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](http://hl7.org/fhir/R4/questionnaireresponse.html) into a final score and represent the score as an Observation.
Relationships established by OBX-4 usage
Related measurements the observation is made from
The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.
All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](http://hl7.org/fhir/R4/observation.html#obsgrouping) below.
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.
For a discussion on the ways Observations can be assembled in groups together see [Notes](http://hl7.org/fhir/R4/observation.html#notes) below.
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.
Type of component observation (code / type)
Describes what was observed. Sometimes this is called the observation "code".
*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was 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 additional guidance, see the [Notes section](http://hl7.org/fhir/R4/observation.html#notes) below.
363714003 |Interprets| < 441742003 |Evaluation finding|
Provides a reason why the expected value in the element Observation.component.value[x] is missing.
"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
Provides guide for interpretation of component result
Guidance on how to interpret the value by comparison to a normal or recommended range.
Whether CMV infection occurred during pregnancy
Observation for CMV infection during pregnancy (focus: the mother)
Whether bacterial meningitis was present
Overall neonatal hearing screening result
Observation for overall neonatal hearing screening
Brain stem auditory evoked potential, function
What the observation is about, when it is not about the subject of record
normal result | abnormal result | invalid result | test not done
Hearing screening result for the left ear
Observation for hearing screening - left ear
An explicit statement of laterality of a lesion, or a treatment, etc.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).
Hearing screening result for the right ear
Observation for hearing screening - right ear
Whether severe head trauma occurred during delivery
Observation for severe head trauma during delivery
Observation for abnormal pupil inspection
Eye movement and position finding - left eye
Observation for eye movement and position - left eye
intermittent strabismus | continuous strabismus | nystagmus present
Eye movement and position finding - right eye
Observation for eye movement and position - right eye
Treatment the patient has followed with an ophthalmologist
Observation for treatment with an ophthalmologist
prescription of spectacles | application of eye patch | surgical procedure on eye proper | (extensible)
Digital Signature - base64 encoded. XML-DSig or a JWT.
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.
The first entry in this bundle is always a Composition.