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{
  "resourceType": "StructureDefinition",
  "id": "observation-results-radiology-ca-ps",
  "url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps",
  "name": "ObservationResultsRadiologyPSCA",
  "title": "Observation Results: Radiology (PS-CA)",
  "status": "draft",
  "experimental": false,
  "date": "2023-12-06T08:00:00+00:00",
  "description": "This profile represents the constraints applied to the Observation resource by the pan-Canadian Patient Summary project, which specifies a radiology observation for a patient summary based on the FHIR standard R4.\n\nThis observation may represent the conclusions of a diagnostic procedure such a Chest RX, or it may group the set of results produced by that single or multi-modality procedure.\n\nIn the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may references the atomic results of the study as \"child observations\".\n\nIt also allows providing details about the related study using the partOf element referring to an ImagingStudy resource.",
  "copyright": "Copyright © 2021,2022,2023 Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-ca-ps",
  "derivation": "constraint",
  "snapshot": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "Measurements and simple assertions",
        "definition": "Measurements and simple assertions made about a patient, device or other subject.",
        "comment": "Preliminary analysis has identified that radiology result information may have limited support in current systems intending to produce a diagnostic results section in their initial patient summaries, further feedback and investigation is required with participating jurisdictions to confirm the support of any of the radiology observation elements - until then, initial constraints put forth in the IPS-UV specification have been mantained with minimal relaxation.",
        "alias": [
          "Vital Signs",
          "Measurement",
          "Results",
          "Tests"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation",
          "min": 0,
          "max": "*"
        },
        "constraint": [
          {
            "key": "dom-2",
            "severity": "error",
            "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
            "expression": "contained.contained.empty()",
            "xpath": "not(parent::f:contained and f:contained)",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-4",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
            "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
            "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-3",
            "severity": "error",
            "human": "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",
            "expression": "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()",
            "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
                "valueBoolean": true
              },
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
                "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
              }
            ],
            "key": "dom-6",
            "severity": "warning",
            "human": "A resource should have narrative for robust management",
            "expression": "text.`div`.exists()",
            "xpath": "exists(f:text/h:div)",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-5",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a security label",
            "expression": "contained.meta.security.empty()",
            "xpath": "not(exists(f:contained/*/f:meta/f:security))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "obs-7",
            "severity": "error",
            "human": "If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present",
            "expression": "value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()",
            "xpath": "not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@value]))",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "obs-6",
            "severity": "error",
            "human": "dataAbsentReason SHALL only be present if Observation.value[x] is not present",
            "expression": "dataAbsentReason.empty() or value.empty()",
            "xpath": "not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "key": "psca-rad-1",
            "severity": "error",
            "human": "component and hasMember are mutually exclusive",
            "expression": "hasMember.empty() or component.empty()",
            "source": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "Entity. Role, or Act"
          },
          {
            "identity": "workflow",
            "map": "Event"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity|"
          },
          {
            "identity": "v2",
            "map": "OBX"
          },
          {
            "identity": "rim",
            "map": "Observation[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.id",
        "path": "Observation.id",
        "short": "Logical id of this artifact",
        "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
        "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "isSummary": true
      },
      {
        "id": "Observation.meta",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.meta",
        "short": "Metadata about the resource",
        "definition": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.meta",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Meta"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.implicitRules",
        "path": "Observation.implicitRules",
        "short": "A set of rules under which this content was created",
        "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.implicitRules",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "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",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.language",
        "path": "Observation.language",
        "short": "Language of the resource content",
        "definition": "The base language in which the resource is written.",
        "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.language",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
              "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "Language"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
              "valueBoolean": true
            }
          ],
          "strength": "preferred",
          "description": "A human language.",
          "valueSet": "http://hl7.org/fhir/ValueSet/languages"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.text",
        "short": "Text summary of the resource, for human interpretation",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "narrative",
          "html",
          "xhtml",
          "display"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "DomainResource.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Narrative"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "Act.text?"
          }
        ]
      },
      {
        "id": "Observation.contained",
        "path": "Observation.contained",
        "short": "Contained, inline Resources",
        "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
        "comment": "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.",
        "alias": [
          "inline resources",
          "anonymous resources",
          "contained resources"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.contained",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Resource"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "Entity. Role, or Act"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.modifierExtension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Extensions that cannot be ignored",
        "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.identifier",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.identifier",
        "short": "Business Identifier for observation",
        "definition": "A unique identifier assigned to this observation.",
        "requirements": "Allows observations to be distinguished and referenced.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.identifier",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
          },
          {
            "identity": "rim",
            "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]"
          },
          {
            "identity": "servd",
            "map": "Identifier"
          },
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "v2",
            "map": "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."
          },
          {
            "identity": "rim",
            "map": "id"
          }
        ]
      },
      {
        "id": "Observation.basedOn",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.basedOn",
        "short": "Fulfills plan, proposal or order",
        "definition": "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.",
        "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
        "requirements": "Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.",
        "alias": [
          "Fulfills"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.basedOn",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/CarePlan",
              "http://hl7.org/fhir/StructureDefinition/DeviceRequest",
              "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
              "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
              "http://hl7.org/fhir/StructureDefinition/NutritionOrder",
              "http://hl7.org/fhir/StructureDefinition/ServiceRequest"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "workflow",
            "map": "Event.basedOn"
          },
          {
            "identity": "v2",
            "map": "ORC"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.partOf",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.partOf",
        "short": "Part of referenced event",
        "definition": "A larger event of which this particular Observation is a component or step.  For example,  an observation as part of a procedure.",
        "comment": "To link an Observation to an Encounter use `encounter`.  See the  [Notes](observation.html#obsgrouping) below for guidance on referencing another Observation.",
        "alias": [
          "Container"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.partOf",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/imagingstudy-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "workflow",
            "map": "Event.partOf"
          },
          {
            "identity": "v2",
            "map": "Varies by domain"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=FLFS].target"
          }
        ]
      },
      {
        "id": "Observation.status",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
            "valueString": "default: final"
          }
        ],
        "path": "Observation.status",
        "short": "registered | preliminary | final | amended +",
        "definition": "The status of the result value.",
        "comment": "Only imaging observations with a status of \"final\" may be included in a patient summary.\n\n**Feedback is requested on whether this is too restrictive, and, e.g. \"amended\" or \"corrected\" should also be allowed.**",
        "requirements": "Need to track the status of individual results. Some results are finalized before the whole report is finalized.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.status",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "fixedCode": "final",
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": true,
        "isModifierReason": "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",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationStatus"
            }
          ],
          "strength": "required",
          "description": "Codes providing the status of an observation.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-status|4.0.1"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "FiveWs.status"
          },
          {
            "identity": "sct-concept",
            "map": "< 445584004 |Report by finality status|"
          },
          {
            "identity": "v2",
            "map": "OBX-11"
          },
          {
            "identity": "rim",
            "map": "status  Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of \"revise\""
          }
        ]
      },
      {
        "id": "Observation.category",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "short": "Classification of  type of observation",
        "definition": "A code that classifies the general type of observation being made. In this profile, fixed to \"imaging\".",
        "comment": "At least one category code should be fixed to \"imaging\". This supports filtering for the types of observations that are retrieved and displayed",
        "requirements": "Used for filtering what observations are retrieved and displayed.",
        "min": 1,
        "max": "*",
        "base": {
          "path": "Observation.category",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCategory"
            }
          ],
          "strength": "preferred",
          "description": "Codes for high level observation categories.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-category"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code"
          }
        ]
      },
      {
        "id": "Observation.category:radiology",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.category",
        "sliceName": "radiology",
        "short": "Classification of  type of observation",
        "definition": "A code that classifies the general type of observation being made.",
        "comment": "In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once.  The level of granularity is defined by the category concepts in the value set.",
        "requirements": "Used for filtering what observations are retrieved and displayed.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.category",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/observation-category",
              "code": "imaging"
            }
          ]
        },
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCategory"
            }
          ],
          "strength": "preferred",
          "description": "Codes for high level observation categories.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-category"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code"
          }
        ]
      },
      {
        "id": "Observation.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.code",
        "label": "Diagnostic Procedure Code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "Describes what was observed. Sometimes this is called the observation \"name\". In this profile this may may correspond to the procedure code (e.g. Chest X-Ray).",
        "comment": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "alias": [
          "Name"
        ],
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            },
            {
              "extension": [
                {
                  "url": "purpose",
                  "valueCode": "candidate"
                },
                {
                  "url": "valueSet",
                  "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips"
                },
                {
                  "url": "documentation",
                  "valueMarkdown": "LOINC Radiology Observation codes utilized in IPS. This additional binding is surfaced to socialize the value sets that are proposed for international exchange in IPS. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
                }
              ],
              "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
            }
          ],
          "strength": "example",
          "description": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC",
          "valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/pCLOCD"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          },
          {
            "identity": "sct-attr",
            "map": "116680003 |Is a|"
          }
        ]
      },
      {
        "id": "Observation.subject",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.subject",
        "short": "Who and/or what the observation is about",
        "definition": "The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.  Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.\n\nIn this profile, subject is constrained to the patient.",
        "comment": "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.",
        "requirements": "Observations have no value if you don't know who or what they're about.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.subject",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "workflow",
            "map": "Event.subject"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "v2",
            "map": "PID-3"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=RTGT]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "Observation.subject.id",
        "path": "Observation.subject.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.subject.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.subject.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.subject.reference",
        "path": "Observation.subject.reference",
        "short": "Literal reference, Relative, internal or absolute URL",
        "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
        "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Reference.reference",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ele-1",
          "ref-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.subject.type",
        "path": "Observation.subject.type",
        "short": "Type the reference refers to (e.g. \"Patient\")",
        "definition": "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).",
        "comment": "This element is used to indicate the type of  the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "FHIRResourceTypeExt"
            }
          ],
          "strength": "extensible",
          "description": "Aa resource (or, for logical models, the URI of the logical model).",
          "valueSet": "http://hl7.org/fhir/ValueSet/resource-types"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.subject.identifier",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.subject.identifier",
        "short": "Logical reference, when literal reference is not known",
        "definition": "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
        "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference.  For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport).  One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.identifier",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
          },
          {
            "identity": "rim",
            "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]"
          },
          {
            "identity": "servd",
            "map": "Identifier"
          },
          {
            "identity": "rim",
            "map": ".identifier"
          }
        ]
      },
      {
        "id": "Observation.subject.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.subject.display",
        "short": "Text alternative for the resource",
        "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
        "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.display",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.focus",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "trial-use"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.focus",
        "short": "What the observation is about, when it is not about the subject of record",
        "definition": "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.",
        "comment": "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](extension-observation-focuscode.html).",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.focus",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=SBJ]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "Observation.encounter",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.encounter",
        "short": "Healthcare event during which this observation is made",
        "definition": "The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made.",
        "comment": "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).",
        "requirements": "For some observations it may be important to know the link between an observation and a particular encounter.",
        "alias": [
          "Context"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.encounter",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Encounter"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "workflow",
            "map": "Event.context"
          },
          {
            "identity": "w5",
            "map": "FiveWs.context"
          },
          {
            "identity": "v2",
            "map": "PV1"
          },
          {
            "identity": "rim",
            "map": "inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.effective[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.effective[x]",
        "short": "Clinically relevant time/time-period for observation",
        "definition": "The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the \"physiologically relevant time\". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.",
        "comment": "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](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.",
        "requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.",
        "alias": [
          "Occurrence"
        ],
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.effective[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "psca-rad-2",
            "severity": "error",
            "human": "Datetime must be at least to day",
            "expression": "$this.ofType(dateTime).empty() or ($this as dateTime).toString().length() >= 8",
            "xpath": "not(boolean(effectiveDateTime)) or f:matches(effectiveDateTime,/\\d{4}-[01]\\d-[0-3]\\dT[0-2]\\d:[0-5]\\d([+-][0-2]\\d:[0-5]\\d|Z)/)",
            "source": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "workflow",
            "map": "Event.occurrence[x]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.done[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)"
          },
          {
            "identity": "rim",
            "map": "effectiveTime"
          }
        ]
      },
      {
        "id": "Observation.effective[x].id",
        "path": "Observation.effective[x].id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.effective[x].extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.effective[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "Systems that have requirements to always populate .effective[X] do not need to demonstrate this element. Receiving systems are expected not to error if they receive a patient summary with a data absent reason on this element.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.effective[x].extension:data-absent-reason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.effective[x].extension",
        "sliceName": "data-absent-reason",
        "short": "effective[x] absence reason",
        "definition": "Provides a reason why the effectiveTime is missing.",
        "comment": "Systems that have requirements to always populate .effective[X] do not need to demonstrate this element. Receiving systems are expected not to error if they receive a patient summary with a data absent reason on this element.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension",
            "profile": [
              "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mustSupport": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "ANY.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.issued",
        "path": "Observation.issued",
        "short": "Date/Time this version was made available",
        "definition": "The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.",
        "comment": "For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.issued",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "instant"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "w5",
            "map": "FiveWs.recorded"
          },
          {
            "identity": "v2",
            "map": "OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=AUT].time"
          }
        ]
      },
      {
        "id": "Observation.performer",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.performer",
        "short": "Who is responsible for the observation",
        "definition": "Who was responsible for asserting the observed value as \"true\".",
        "comment": "IPS considers this a Must Support element with a minimum cardinality of 1. While all jurisdictions supporting pathology in patient summary have indicated they can populate performer, some jurisdictions indicated this may be populated with provincial health authority information that may not be clinically meaningful. This constraint may be evaluated in IPS and PS-CA in the next release as updates are made to the underlying data models that underpin the FHIR profiles.",
        "requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.",
        "min": 1,
        "max": "*",
        "base": {
          "path": "Observation.performer",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps",
              "http://hl7.org/fhir/StructureDefinition/CareTeam",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "workflow",
            "map": "Event.performer.actor"
          },
          {
            "identity": "w5",
            "map": "FiveWs.actor"
          },
          {
            "identity": "v2",
            "map": "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'"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=PRF]"
          }
        ]
      },
      {
        "id": "Observation.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "short": "Actual result",
        "definition": "The information determined as a result of making the observation, if the information has a simple value.",
        "comment": "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](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          },
          {
            "code": "CodeableConcept"
          },
          {
            "code": "string"
          },
          {
            "code": "boolean"
          },
          {
            "code": "integer"
          },
          {
            "code": "Range"
          },
          {
            "code": "Ratio"
          },
          {
            "code": "SampledData"
          },
          {
            "code": "time"
          },
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          }
        ],
        "condition": [
          "ele-1",
          "obs-7"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "< 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          }
        ]
      },
      {
        "id": "Observation.value[x]:valueString",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.value[x]",
        "sliceName": "valueString",
        "label": "Overall Conclusion",
        "short": "Actual result",
        "definition": "The information determined as a result of making the observation, if the information has a simple value.",
        "comment": "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](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ele-1",
          "obs-7"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "< 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          }
        ]
      },
      {
        "id": "Observation.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.dataAbsentReason",
        "short": "Why the result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.value[x] is missing.",
        "comment": "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\".   \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.note",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.note",
        "short": "Comments about the observation",
        "definition": "Comments about the observation or the results.",
        "comment": "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.",
        "requirements": "Need to be able to provide free text additional information.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.note",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Annotation"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "Act"
          },
          {
            "identity": "v2",
            "map": "NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"
          },
          {
            "identity": "rim",
            "map": "subjectOf.observationEvent[code=\"annotation\"].value"
          }
        ]
      },
      {
        "id": "Observation.bodySite",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.bodySite",
        "short": "Observed body part",
        "definition": "Indicates the site on the subject's body where the observation was made (i.e. the target site).",
        "comment": "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.   \n\nIf 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](extension-bodysite.html).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.bodySite",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "BodySite"
            }
          ],
          "strength": "example",
          "description": "Codes describing anatomical locations. May include laterality.",
          "valueSet": "http://hl7.org/fhir/ValueSet/body-site"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 123037004 |Body structure|"
          },
          {
            "identity": "v2",
            "map": "OBX-20"
          },
          {
            "identity": "rim",
            "map": "targetSiteCode"
          },
          {
            "identity": "sct-attr",
            "map": "718497002 |Inherent location|"
          }
        ]
      },
      {
        "id": "Observation.method",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.method",
        "short": "How it was done",
        "definition": "Indicates the mechanism used to perform the observation.",
        "comment": "Only used if not implicit in code for Observation.code.",
        "requirements": "In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.method",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMethod"
            }
          ],
          "strength": "example",
          "description": "Methods for simple observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-methods"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "OBX-17"
          },
          {
            "identity": "rim",
            "map": "methodCode"
          }
        ]
      },
      {
        "id": "Observation.specimen",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.specimen",
        "short": "Specimen used for this observation",
        "definition": "The specimen that was used when this observation was made.",
        "comment": "Should only be used if not implicit in code found in `Observation.code`.  Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.specimen",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Specimen"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "sct-concept",
            "map": "< 123038009 |Specimen|"
          },
          {
            "identity": "v2",
            "map": "SPM segment"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=SPC].specimen"
          },
          {
            "identity": "sct-attr",
            "map": "704319004 |Inherent in|"
          }
        ]
      },
      {
        "id": "Observation.device",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.device",
        "short": "(Measurement) Device",
        "definition": "The device used to generate the observation data.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.device",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Device",
              "http://hl7.org/fhir/StructureDefinition/DeviceMetric"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "sct-concept",
            "map": "< 49062001 |Device|"
          },
          {
            "identity": "v2",
            "map": "OBX-17 / PRT -10"
          },
          {
            "identity": "rim",
            "map": "participation[typeCode=DEV]"
          },
          {
            "identity": "sct-attr",
            "map": "424226004 |Using device|"
          }
        ]
      },
      {
        "id": "Observation.referenceRange",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange",
        "short": "Provides guide for interpretation",
        "definition": "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.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.referenceRange",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "obs-3",
            "severity": "error",
            "human": "Must have at least a low or a high or text",
            "expression": "low.exists() or high.exists() or text.exists()",
            "xpath": "(exists(f:low) or exists(f:high)or exists(f:text))",
            "source": "http://hl7.org/fhir/StructureDefinition/Observation"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.id",
        "path": "Observation.referenceRange.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.low",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.low",
        "short": "Low Range, if relevant",
        "definition": "The value of the low bound of the reference range.  The low bound of the reference range endpoint is inclusive of the value (e.g.  reference range is >=5 - <=9). If the low bound is omitted,  it is assumed to be meaningless (e.g. reference range is <=2.3).",
        "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.low",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity",
            "profile": [
              "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
            ]
          }
        ],
        "condition": [
          "ele-1",
          "obs-3"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "qty-3",
            "severity": "error",
            "human": "If a code for the unit is present, the system SHALL also be present",
            "expression": "code.empty() or system.exists()",
            "xpath": "not(exists(f:code)) or exists(f:system)",
            "source": "http://hl7.org/fhir/StructureDefinition/Quantity"
          },
          {
            "key": "sqty-1",
            "severity": "error",
            "human": "The comparator is not used on a SimpleQuantity",
            "expression": "comparator.empty()",
            "xpath": "not(exists(f:comparator))",
            "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
          }
        ],
        "isModifier": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "SN (see also Range) or CQ"
          },
          {
            "identity": "rim",
            "map": "PQ, IVL<PQ>, MO, CO, depending on the values"
          },
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:IVL_PQ.low"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.high",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.high",
        "short": "High Range, if relevant",
        "definition": "The value of the high bound of the reference range.  The high bound of the reference range endpoint is inclusive of the value (e.g.  reference range is >=5 - <=9). If the high bound is omitted,  it is assumed to be meaningless (e.g. reference range is >= 2.3).",
        "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.high",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity",
            "profile": [
              "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
            ]
          }
        ],
        "condition": [
          "ele-1",
          "obs-3"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "qty-3",
            "severity": "error",
            "human": "If a code for the unit is present, the system SHALL also be present",
            "expression": "code.empty() or system.exists()",
            "xpath": "not(exists(f:code)) or exists(f:system)",
            "source": "http://hl7.org/fhir/StructureDefinition/Quantity"
          },
          {
            "key": "sqty-1",
            "severity": "error",
            "human": "The comparator is not used on a SimpleQuantity",
            "expression": "comparator.empty()",
            "xpath": "not(exists(f:comparator))",
            "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
          }
        ],
        "isModifier": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "SN (see also Range) or CQ"
          },
          {
            "identity": "rim",
            "map": "PQ, IVL<PQ>, MO, CO, depending on the values"
          },
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:IVL_PQ.high"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.type",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.type",
        "short": "Reference range qualifier",
        "definition": "Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.",
        "comment": "This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed.",
        "requirements": "Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc.,  - for proper interpretation.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationRangeMeaning"
            }
          ],
          "strength": "preferred",
          "description": "Code for the meaning of a reference range.",
          "valueSet": "http://hl7.org/fhir/ValueSet/referencerange-meaning"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values| OR  \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR  \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|"
          },
          {
            "identity": "v2",
            "map": "OBX-10"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.appliesTo",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.appliesTo",
        "short": "Reference range population",
        "definition": "Codes to indicate the target population this reference range applies to.  For example, a reference range may be based on the normal population or a particular sex or race.  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.",
        "comment": "This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed.",
        "requirements": "Need to be able to identify the target population for proper interpretation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.referenceRange.appliesTo",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationRangeType"
            }
          ],
          "strength": "example",
          "description": "Codes identifying the population the reference range applies to.",
          "valueSet": "http://hl7.org/fhir/ValueSet/referencerange-appliesto"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values| OR  \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR  \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|"
          },
          {
            "identity": "v2",
            "map": "OBX-10"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.age",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.referenceRange.age",
        "short": "Applicable age range, if relevant",
        "definition": "The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.",
        "comment": "The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.",
        "requirements": "Some analytes vary greatly over age.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.age",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Range"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "rng-2",
            "severity": "error",
            "human": "If present, low SHALL have a lower value than high",
            "expression": "low.empty() or high.empty() or (low <= high)",
            "xpath": "not(exists(f:low/f:value/@value)) or not(exists(f:high/f:value/@value)) or (number(f:low/f:value/@value) <= number(f:high/f:value/@value))",
            "source": "http://hl7.org/fhir/StructureDefinition/Range"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "NR and also possibly SN (but see also quantity)"
          },
          {
            "identity": "rim",
            "map": "IVL<QTY[not(type=\"TS\")]> [lowClosed=\"true\" and highClosed=\"true\"]or URG<QTY[not(type=\"TS\")]>"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=\"age\"].value"
          }
        ]
      },
      {
        "id": "Observation.referenceRange.text",
        "path": "Observation.referenceRange.text",
        "short": "Text based reference range in an observation",
        "definition": "Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation.  An example would be a reference value of \"Negative\" or a list or table of \"normals\".",
        "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.referenceRange.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "OBX-7"
          },
          {
            "identity": "rim",
            "map": "value:ST"
          }
        ]
      },
      {
        "id": "Observation.hasMember",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.hasMember",
        "short": "Related resource that belongs to the Observation group",
        "definition": "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.",
        "comment": "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](observation.html#obsgrouping) below.  Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.html)  into a final score and represent the score as an Observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.hasMember",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "v2",
            "map": "Relationships established by OBX-4 usage"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship"
          }
        ]
      },
      {
        "id": "Observation.derivedFrom",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.derivedFrom",
        "short": "Related measurements the observation is made from",
        "definition": "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.",
        "comment": "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](observation.html#obsgrouping) below.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.derivedFrom",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/DocumentReference",
              "http://hl7.org/fhir/StructureDefinition/ImagingStudy",
              "http://hl7.org/fhir/StructureDefinition/Media",
              "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse",
              "http://hl7.org/fhir/StructureDefinition/Observation",
              "http://hl7.org/fhir/StructureDefinition/MolecularSequence"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ref-1",
            "severity": "error",
            "human": "SHALL have a contained resource if a local reference is provided",
            "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
            "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Reference"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
          },
          {
            "identity": "v2",
            "map": "Relationships established by OBX-4 usage"
          },
          {
            "identity": "rim",
            "map": ".targetObservation"
          }
        ]
      },
      {
        "id": "Observation.component",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "value"
            }
          ],
          "description": "Slicing based on value[x] type.",
          "rules": "closed"
        },
        "short": "Component results",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "Systems that do not supply radiology results using component are not expected to demonstrate for this profile. The slicing constraints from IPS have been maintained in the meantime to convey expectations for structured data for systems that do support component.",
        "requirements": "Required if not(exists(Observation.valueString))",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Type of component observation (code / type)",
        "definition": "Describes what was observed. Sometimes this is called the observation \"code\".",
        "comment": "*All* code-value and  component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            }
          ],
          "strength": "example",
          "description": "Codes identifying names of simple observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-codes"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "Actual component result",
        "definition": "The information determined as a result of making the observation, if the information has a simple value.",
        "comment": "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](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          },
          {
            "code": "CodeableConcept"
          },
          {
            "code": "string"
          },
          {
            "code": "boolean"
          },
          {
            "code": "integer"
          },
          {
            "code": "Range"
          },
          {
            "code": "Ratio"
          },
          {
            "code": "SampledData"
          },
          {
            "code": "time"
          },
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          }
        ]
      },
      {
        "id": "Observation.component.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:observationText",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "observationText",
        "short": "Observation Text",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying names of simple observations.",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-txtobs-snomed-dicom-loinc-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "Actual component result",
        "definition": "The information determined as a result of making the observation, if the information has a simple value.",
        "comment": "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](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:observationText.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "observationCode",
        "short": "Observation Code",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying names of simple observations.",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "numericQuantityMeasurement",
        "short": "Observation Measurement, including linear, area and volume quantity measurements",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "A measured amount using UCUM",
        "definition": "A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.\r\nThis profile imposes that the code system for units be UCUM.",
        "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Quantity-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "qty-3",
            "severity": "error",
            "human": "If a code for the unit is present, the system SHALL also be present",
            "expression": "code.empty() or system.exists()",
            "xpath": "not(exists(f:code)) or exists(f:system)",
            "source": "http://hl7.org/fhir/StructureDefinition/Quantity"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "v2",
            "map": "SN (see also Range) or CQ"
          },
          {
            "identity": "rim",
            "map": "PQ, IVL<PQ>, MO, CO, depending on the values"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "numericRangeMeasurement",
        "short": "Observation Measurement, including linear, area and volume range measurements",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "Set of values bounded by low and high",
        "definition": "A set of ordered Quantities defined by a low and high limit.",
        "comment": "The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Range",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Range-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "rng-2",
            "severity": "error",
            "human": "If present, low SHALL have a lower value than high",
            "expression": "low.empty() or high.empty() or (low <= high)",
            "xpath": "not(exists(f:low/f:value/@value)) or not(exists(f:high/f:value/@value)) or (number(f:low/f:value/@value) <= number(f:high/f:value/@value))",
            "source": "http://hl7.org/fhir/StructureDefinition/Range"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "v2",
            "map": "NR and also possibly SN (but see also quantity)"
          },
          {
            "identity": "rim",
            "map": "IVL<QTY[not(type=\"TS\")]> [lowClosed=\"true\" and highClosed=\"true\"]or URG<QTY[not(type=\"TS\")]>"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "numericRatioMeasurement",
        "short": "Observation Measurement, including linear, area and volume ratio measurements",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "A ratio of two Quantity values - a numerator and a denominator",
        "definition": "A relationship of two Quantity values - expressed as a numerator and a denominator.",
        "comment": "The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit.  Where the denominator value is known to be fixed to \"1\", Quantity should be used instead of Ratio.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Ratio",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "rat-1",
            "severity": "error",
            "human": "Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present",
            "expression": "(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())",
            "xpath": "(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))",
            "source": "http://hl7.org/fhir/StructureDefinition/Ratio"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "RTO"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component",
        "sliceName": "numericSampledDataMeasurement",
        "short": "Observation Measurement, including linear, area and volume sampled data measurements",
        "definition": "Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
        "comment": "The IPS-UV specification considers this a Must Support element. Becuase this profile is the base for a number of other PS diagnostic result profiles and not used on some of the other social observation profiles, the Must Support flag on the component element has been maintained until further feedback is provided on whether systems are anticipating to use this as a base profile for other results that don't require the support of component.",
        "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable).   However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "containment by OBX-4?"
          },
          {
            "identity": "rim",
            "map": "outBoundRelationship[typeCode=COMP]"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.id",
        "path": "Observation.component.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.modifierExtension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.code",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.code",
        "short": "Concept - reference to a terminology or just  text",
        "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
        "comment": "For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.",
        "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.code",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "sct-concept",
            "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|"
          },
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": "code"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.value[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.value[x]",
        "short": "Actual component result",
        "definition": "The information determined as a result of making the observation, if the information has a simple value.",
        "comment": "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](observation.html#notes) below.",
        "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Observation.component.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "SampledData"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "sct-concept",
            "map": "363714003 |Interprets| < 441742003 |Evaluation finding|"
          },
          {
            "identity": "v2",
            "map": "OBX.2, OBX.5, OBX.6"
          },
          {
            "identity": "rim",
            "map": "value"
          },
          {
            "identity": "sct-attr",
            "map": "363714003 |Interprets|"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.dataAbsentReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.dataAbsentReason",
        "short": "Why the component result is missing",
        "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
        "comment": "\"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\". \n\nThe 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.",
        "requirements": "For many results it is necessary to handle exceptional values in measurements.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Observation.component.dataAbsentReason",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1",
          "obs-6"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationValueAbsentReason"
            }
          ],
          "strength": "extensible",
          "description": "Codes specifying why the result (`Observation.value[x]`) is missing.",
          "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "value.nullFlavor"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.interpretation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Observation.component.interpretation",
        "short": "High, low, normal, etc.",
        "definition": "A categorical assessment of an observation value.  For example, high, low, normal.",
        "comment": "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.",
        "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
        "alias": [
          "Abnormal Flag"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.interpretation",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationInterpretation"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying interpretations of observations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "v2",
            "map": "CE/CNE/CWE"
          },
          {
            "identity": "rim",
            "map": "CD"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
          },
          {
            "identity": "sct-concept",
            "map": "< 260245000 |Findings values|"
          },
          {
            "identity": "v2",
            "map": "OBX-8"
          },
          {
            "identity": "rim",
            "map": "interpretationCode"
          },
          {
            "identity": "sct-attr",
            "map": "363713009 |Has interpretation|"
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.referenceRange",
        "path": "Observation.component.referenceRange",
        "short": "Provides guide for interpretation of component result",
        "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.",
        "comment": "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.",
        "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Observation.component.referenceRange",
          "min": 0,
          "max": "*"
        },
        "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange",
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX.7"
          },
          {
            "identity": "rim",
            "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"
          }
        ]
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "comment": "Preliminary analysis has identified that radiology result information may have limited support in current systems intending to produce a diagnostic results section in their initial patient summaries, further feedback and investigation is required with participating jurisdictions to confirm the support of any of the radiology observation elements - until then, initial constraints put forth in the IPS-UV specification have been mantained with minimal relaxation.",
        "constraint": [
          {
            "key": "psca-rad-1",
            "severity": "error",
            "human": "component and hasMember are mutually exclusive",
            "expression": "hasMember.empty() or component.empty()"
          }
        ]
      },
      {
        "id": "Observation.partOf",
        "path": "Observation.partOf",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/imagingstudy-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.status",
        "path": "Observation.status",
        "comment": "Only imaging observations with a status of \"final\" may be included in a patient summary.\n\n**Feedback is requested on whether this is too restrictive, and, e.g. \"amended\" or \"corrected\" should also be allowed.**"
      },
      {
        "id": "Observation.category",
        "path": "Observation.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "definition": "A code that classifies the general type of observation being made. In this profile, fixed to \"imaging\".",
        "comment": "At least one category code should be fixed to \"imaging\". This supports filtering for the types of observations that are retrieved and displayed",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.category:radiology",
        "path": "Observation.category",
        "sliceName": "radiology",
        "min": 1,
        "max": "1",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/observation-category",
              "code": "imaging"
            }
          ]
        },
        "mustSupport": true
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "label": "Diagnostic Procedure Code",
        "definition": "Describes what was observed. Sometimes this is called the observation \"name\". In this profile this may may correspond to the procedure code (e.g. Chest X-Ray).",
        "comment": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element",
        "mustSupport": true,
        "binding": {
          "extension": [
            {
              "extension": [
                {
                  "url": "purpose",
                  "valueCode": "candidate"
                },
                {
                  "url": "valueSet",
                  "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips"
                },
                {
                  "url": "documentation",
                  "valueMarkdown": "LOINC Radiology Observation codes utilized in IPS. This additional binding is surfaced to socialize the value sets that are proposed for international exchange in IPS. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
                }
              ],
              "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
            }
          ],
          "strength": "example",
          "description": "Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC",
          "valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/pCLOCD"
        }
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "definition": "The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.  Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.\n\nIn this profile, subject is constrained to the patient.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "constraint": [
          {
            "key": "psca-rad-2",
            "severity": "error",
            "human": "Datetime must be at least to day",
            "expression": "$this.ofType(dateTime).empty() or ($this as dateTime).toString().length() >= 8",
            "xpath": "not(boolean(effectiveDateTime)) or f:matches(effectiveDateTime,/\\d{4}-[01]\\d-[0-3]\\dT[0-2]\\d:[0-5]\\d([+-][0-2]\\d:[0-5]\\d|Z)/)"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x].extension:data-absent-reason",
        "path": "Observation.effective[x].extension",
        "comment": "Systems that have requirements to always populate .effective[X] do not need to demonstrate this element. Receiving systems are expected not to error if they receive a patient summary with a data absent reason on this element."
      },
      {
        "id": "Observation.performer",
        "path": "Observation.performer",
        "comment": "IPS considers this a Must Support element with a minimum cardinality of 1. While all jurisdictions supporting pathology in patient summary have indicated they can populate performer, some jurisdictions indicated this may be populated with provincial health authority information that may not be clinically meaningful. This constraint may be evaluated in IPS and PS-CA in the next release as updates are made to the underlying data models that underpin the FHIR profiles.",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps",
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps",
              "http://hl7.org/fhir/StructureDefinition/CareTeam",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.valueString",
        "path": "Observation.valueString",
        "label": "Overall Conclusion",
        "type": [
          {
            "code": "string"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.hasMember",
        "path": "Observation.hasMember",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "value"
            }
          ],
          "description": "Slicing based on value[x] type.",
          "rules": "closed"
        },
        "comment": "Systems that do not supply radiology results using component are not expected to demonstrate for this profile. The slicing constraints from IPS have been maintained in the meantime to convey expectations for structured data for systems that do support component.",
        "requirements": "Required if not(exists(Observation.valueString))",
        "mustSupport": true
      },
      {
        "id": "Observation.component:observationText",
        "path": "Observation.component",
        "sliceName": "observationText",
        "short": "Observation Text"
      },
      {
        "id": "Observation.component:observationText.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationCode"
            }
          ],
          "strength": "extensible",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-txtobs-snomed-dicom-loinc-uv-ips"
        }
      },
      {
        "id": "Observation.component:observationText.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "string"
          }
        ]
      },
      {
        "id": "Observation.component:observationCode",
        "path": "Observation.component",
        "sliceName": "observationCode",
        "short": "Observation Code"
      },
      {
        "id": "Observation.component:observationCode.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "strength": "extensible",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips"
        }
      },
      {
        "id": "Observation.component:observationCode.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:numericQuantityMeasurement",
        "path": "Observation.component",
        "sliceName": "numericQuantityMeasurement",
        "short": "Observation Measurement, including linear, area and volume quantity measurements"
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        }
      },
      {
        "id": "Observation.component:numericQuantityMeasurement.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "Quantity",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Quantity-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:numericRangeMeasurement",
        "path": "Observation.component",
        "sliceName": "numericRangeMeasurement",
        "short": "Observation Measurement, including linear, area and volume range measurements"
      },
      {
        "id": "Observation.component:numericRangeMeasurement.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        }
      },
      {
        "id": "Observation.component:numericRangeMeasurement.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "Range",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Range-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:numericRatioMeasurement",
        "path": "Observation.component",
        "sliceName": "numericRatioMeasurement",
        "short": "Observation Measurement, including linear, area and volume ratio measurements"
      },
      {
        "id": "Observation.component:numericRatioMeasurement.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        }
      },
      {
        "id": "Observation.component:numericRatioMeasurement.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "Ratio",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement",
        "path": "Observation.component",
        "sliceName": "numericSampledDataMeasurement",
        "short": "Observation Measurement, including linear, area and volume sampled data measurements"
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.code",
        "path": "Observation.component.code",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ObservationMeasurements"
            }
          ],
          "strength": "extensible",
          "description": "Codes identifying numeric measurements",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-snomed-dicom-uv-ips"
        }
      },
      {
        "id": "Observation.component:numericSampledDataMeasurement.value[x]",
        "path": "Observation.component.value[x]",
        "min": 1,
        "type": [
          {
            "code": "SampledData"
          }
        ]
      }
    ]
  }
}

name : ObservationResultsRadiologyPSCA

{

}