Scope and usage

The MedComHomeCareObservation profile holds information about the observation results from the municipal acute care team The MedComHomeCareObservations are collected in a MedComHomeCareDiagnosticReport, that is sent as a MedComHomeCareObservation message to the general practitioner.

The observations results needs to have a observation code that defines the type of the observation. The code for the observation shall be seleceted from a national analysis repertoire, that defines which observations and assesments methods the municipal acute care team can performe and send to the general practitioner. The national analysis repertoire can be found here.

Codes

In a Observation resource, codes from CodeSystems are used to describe what is observed in the elements Observation.code.coding. In the element Observation.code.coding two CodeSystem are specified.

• The NPU codes are the preferred first choice in official Danish health IT-systems and most used laboratory codes. NPU codes hase NPU prefixes in the begining of the code.
• MedCom codes are Danish codes that are refered as MCS- codes.

It is required to send the long and short name of the analysis. Both the long and short name of the performed observation can be fund on med medcom's terminology server. Click here to see NPU observation codes. Click here to see MCS observation codes.

Status

In a Observation resource, it is required to specify the status of the result. When nurse from the acute care team perform the analysis and the result from the analysis is ready then the. HomeCareObservation.status shall be #final.

Interpretation

In HomeCareObservation it is required to send information that result of the observation is not interpreted (Dansk: ikke reference vurderet). Therefore i is required that the observation.interpretation.coding.code is "NI" not interpreted.

Observation result

The result of the observation shall be expresed using eighter Observation.value[x]:valueQuantity and Observation.value[x]:valueString element. If the observation result is numerical then the Observation.value[x]:valueQuantity shall be used and if the result is alphanumeric e.g. positive/negative then the Observation.value[x]:valueString element shall be used. Both elemets Observation.value[x]:valueQuantity og Observation.value[x]:valueString are restricted to max 12 character due to limitations in laborartory kort.

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

This structure is derived from MedComCoreObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	MedComCoreObservation	Measurements and simple assertions
code
coding		0..*	Coding	Code defined by a terminology system
display	S	0..1	string	Representation defined by the system
Slices for coding				Content/Rules for all slices
coding:LOINC		0..1	Coding	LOINC code for the observation
display	S	0..1	string	Representation defined by the system
coding:SNOMEDCT		0..1	Coding	SNOMED CT code for the observation
display	S	0..1	string	Representation defined by the system
coding:NPU		0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system		1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required)
display	S	0..1	string	Representation defined by the system
coding:IEEE		0..1	Coding	IEEE code for the observation
display	S	0..1	string	Representation defined by the system
coding:MedCom		0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system		1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required)
display	S	0..1	string	Representation defined by the system
coding:SKS		0..1	Coding	SKS code for the observation
display	S	0..1	string	Representation defined by the system
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	S	0..1	Quantity	Actual result Max Length:12
value[x]:valueString	S	0..1	string	Actual result Max Length:12
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required)
coding
code		0..1	code	Symbol in syntax defined by the system Required Pattern: NI
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code.coding:NPU.system	required	NPUObservationCodesValueSet http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	MedComObservationValueSet http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	MedComCoreObservation	Measurements and simple assertions dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present dk-core-observation-mandatory-units: If value is specified then unit and/or code must be specified
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
coding:All Slices				Content/Rules for all slices
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: http://loinc.org
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: https://www.snomed.org/
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required) ele-1: All FHIR elements must have a @value or children Fixed Value: urn:oid:1.2.208.176.2.1
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: urn:iso:std:iso:11073:10101
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required) ele-1: All FHIR elements must have a @value or children Fixed Value: https://terminology.medcom.dk/fhir/observation-code
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:SKS	Σ	0..1	Coding	SKS code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: urn:oid:1.2.208.176.2.4
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt). ele-1: All FHIR elements must have a @value or children
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result ele-1: All FHIR elements must have a @value or children Max Length:12
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. ele-1: All FHIR elements must have a @value or children
system	ΣC	0..1	uri	System that defines coded unit form ele-1: All FHIR elements must have a @value or children Required Pattern: http://unitsofmeasure.org
value[x]:valueString	SΣC	0..1	string	Actual result ele-1: All FHIR elements must have a @value or children Max Length:12
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required) ele-1: All FHIR elements must have a @value or children
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.code.coding:NPU.system	required	Fixed Value: urn:oid:1.2.208.176.2.1 http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	Fixed Value: https://terminology.medcom.dk/fhir/observation-code http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified : Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()
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()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	MedComCoreObservation	Measurements and simple assertions obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present dk-core-observation-mandatory-units: If value is specified then unit and/or code must be specified
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required)
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: https://www.snomed.org/
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required) Fixed Value: urn:oid:1.2.208.176.2.1
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required) Fixed Value: https://terminology.medcom.dk/fhir/observation-code
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt).
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(Danish Core Practitioner Profile(2.2.0) | Danish Core Organization Profile(2.2.0) | Danish Core Patient Profile(2.2.0) | PractitionerRole | CareTeam | RelatedPerson)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result Max Length:12
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
value[x]:valueString	SΣC	0..1	string	Actual result Max Length:12
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: NI
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar)
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: TechniqesSCTCodes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.snomed.org/
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.1
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://terminology.medcom.dk/fhir/observation-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.code.coding:NPU.system	required	Fixed Value: urn:oid:1.2.208.176.2.1 http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	Fixed Value: https://terminology.medcom.dk/fhir/observation-code http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.method.coding:SCTCode	required	TechniqesSCTCodes http://hl7.dk/fhir/core/ValueSet/TechniqesSCTCodes
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified : Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()
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()

Differential View

This structure is derived from MedComCoreObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	MedComCoreObservation	Measurements and simple assertions
code
coding		0..*	Coding	Code defined by a terminology system
display	S	0..1	string	Representation defined by the system
Slices for coding				Content/Rules for all slices
coding:LOINC		0..1	Coding	LOINC code for the observation
display	S	0..1	string	Representation defined by the system
coding:SNOMEDCT		0..1	Coding	SNOMED CT code for the observation
display	S	0..1	string	Representation defined by the system
coding:NPU		0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
system		1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required)
display	S	0..1	string	Representation defined by the system
coding:IEEE		0..1	Coding	IEEE code for the observation
display	S	0..1	string	Representation defined by the system
coding:MedCom		0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
system		1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required)
display	S	0..1	string	Representation defined by the system
coding:SKS		0..1	Coding	SKS code for the observation
display	S	0..1	string	Representation defined by the system
Slices for value[x]				Content/Rules for all slices
value[x]:valueQuantity	S	0..1	Quantity	Actual result Max Length:12
value[x]:valueString	S	0..1	string	Actual result Max Length:12
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required)
coding
code		0..1	code	Symbol in syntax defined by the system Required Pattern: NI
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code.coding:NPU.system	required	NPUObservationCodesValueSet http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	MedComObservationValueSet http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	MedComCoreObservation	Measurements and simple assertions dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present dk-core-observation-mandatory-units: If value is specified then unit and/or code must be specified
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. ele-1: All FHIR elements must have a @value or children
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system ele-1: All FHIR elements must have a @value or children
coding:All Slices				Content/Rules for all slices
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: http://loinc.org
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: https://www.snomed.org/
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required) ele-1: All FHIR elements must have a @value or children Fixed Value: urn:oid:1.2.208.176.2.1
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: urn:iso:std:iso:11073:10101
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required) ele-1: All FHIR elements must have a @value or children Fixed Value: https://terminology.medcom.dk/fhir/observation-code
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
coding:SKS	Σ	0..1	Coding	SKS code for the observation ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Fixed Value: urn:oid:1.2.208.176.2.4
code	SΣ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Representation defined by the system ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about ele-1: All FHIR elements must have a @value or children
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt). ele-1: All FHIR elements must have a @value or children
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result ele-1: All FHIR elements must have a @value or children Max Length:12
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. ele-1: All FHIR elements must have a @value or children
system	ΣC	0..1	uri	System that defines coded unit form ele-1: All FHIR elements must have a @value or children Required Pattern: http://unitsofmeasure.org
value[x]:valueString	SΣC	0..1	string	Actual result ele-1: All FHIR elements must have a @value or children Max Length:12
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required) ele-1: All FHIR elements must have a @value or children
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.code.coding:NPU.system	required	Fixed Value: urn:oid:1.2.208.176.2.1 http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	Fixed Value: https://terminology.medcom.dk/fhir/observation-code http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified : Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	MedComCoreObservation	Measurements and simple assertions obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present dk-core-observation-mandatory-units: If value is specified then unit and/or code must be specified
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | partial | preliminary | final | corrected | cancelled | entered-in-error Binding: MedComCoreObservationStatus (required)
category		0..*	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: https://www.snomed.org/
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Binding: NPUObservationCodesValueSet (required) Fixed Value: urn:oid:1.2.208.176.2.1
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Binding: MedCom Observation ValueSet (required) Fixed Value: https://terminology.medcom.dk/fhir/observation-code
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	SΣ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(MedComCorePatient) {b}	Who and/or what the observation is about
focus	Σ	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectiveDateTime	SΣ	0..1	dateTime	The date and time the sample was taken (Danish: prøvetegningstidspunkt).
issued	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(Danish Core Practitioner Profile(2.2.0) | Danish Core Organization Profile(2.2.0) | Danish Core Patient Profile(2.2.0) | PractitionerRole | CareTeam | RelatedPerson)	Who is responsible for the observation
Slices for value[x]	ΣC	0..1		Actual result Slice: Unordered, Closed by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	SΣC	0..1	Quantity	Actual result Max Length:12
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
value[x]:valueString	SΣC	0..1	string	Actual result Max Length:12
dataAbsentReason	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation	S	0..1	CodeableConcept	High, low, normal, etc. Binding: http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: NI
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note	S	0..*	Annotation	A comment on the individual result (Danish: Analysekommentar)
bodySite		0..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:SCTCode	Σ	0..1	Coding	Code defined by a terminology system Binding: TechniqesSCTCodes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
specimen		0..1	Reference(Specimen)	Specimen used for this observation
device		0..1	Reference(Device | DeviceMetric)	The device used for the measurement. It is recommended that when information about the device is sent, it is contained in the same Bundle as the Observation the device measured.
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation obs-3: Must have at least a low or a high or text
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:LOINC	Σ	0..1	Coding	LOINC code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SNOMEDCT	Σ	0..1	Coding	SNOMED CT code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.snomed.org/
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NPU	Σ	0..1	Coding	NPU code for the observation. NPU codes are administred by the Danish Health Data Authority.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.1
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:IEEE	Σ	0..1	Coding	IEEE code for the observation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:iso:std:iso:11073:10101
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:MedCom	Σ	0..1	Coding	MedCom code for the observation. MedCom codes are administred by the MedCom.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://terminology.medcom.dk/fhir/observation-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:SKS	Σ	0..1	Coding	SKS code for the observation.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: urn:oid:1.2.208.176.2.4
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Slices for value[x]	Σ	0..1		Actual component result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	Σ	0..1	Quantity	Actual component result
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form Required Pattern: http://unitsofmeasure.org
code	Σ	0..1	code	Coded form of the unit
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	MedComCoreObservationStatus http://medcomfhir.dk/ig/terminology/ValueSet/medcom-core-observation-status
Observation.category	preferred	ObservationCategoryCodes http://hl7.org/fhir/ValueSet/observation-category from the FHIR Standard
Observation.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.code.coding:NPU.system	required	Fixed Value: urn:oid:1.2.208.176.2.1 http://medcomfhir.dk/ig/terminology/ValueSet/NPUObservationCodesValueSet
Observation.code.coding:MedCom.system	required	Fixed Value: https://terminology.medcom.dk/fhir/observation-code http://medcomfhir.dk/ig/terminology/ValueSet/MedComObservationValueSet
Observation.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.interpretation	required	http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-core-interpretation-codes
Observation.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Observation.method	example	ObservationMethods http://hl7.org/fhir/ValueSet/observation-methods from the FHIR Standard
Observation.method.coding:SCTCode	required	TechniqesSCTCodes http://hl7.dk/fhir/core/ValueSet/TechniqesSCTCodes
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes http://hl7.org/fhir/ValueSet/referencerange-meaning from the FHIR Standard
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes http://hl7.org/fhir/ValueSet/referencerange-appliesto from the FHIR Standard
Observation.component.code	example	LOINCCodes (a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes from the FHIR Standard
Observation.component.value[x]:valueQuantity.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason http://hl7.org/fhir/ValueSet/data-absent-reason from the FHIR Standard
Observation.component.interpretation	extensible	ObservationInterpretationCodes http://hl7.org/fhir/ValueSet/observation-interpretation from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dk-core-observation-mandatory-units	error	Observation	If value is specified then unit and/or code must be specified : Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()
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()

This structure is derived from MedComCoreObservation

Summary

Must-Support: 10 elements