Profiling Academy

Custom constraints

Introduction

In this module you will learn more about how and when to create custom constraints based on path navigation. This module assumes you have basic knowledge on profiling. If you prefer to start with the basics, please go through the Introduction to FHIR and profiling or Start profiling module first. In the exercise of this module we will use Forge, the official HL7® FHIR® profile editor. You can download Forge for free.

The topics covered in this module are:

Path navigation: what do we mean by it, how do we use it and when do we need it?
The basics of FHIRPath, a path navigation language designed for FHIR
When and how to use invariants in your profiles
How to add element paths in search parameters

Reading material

A FHIR resource contains a hierarchical list of properties, called elements. There are many cases in which one needs to refer to a particular element in the hierarchy. For example when you want to define the path of a discriminator, the path to a specific element in a search parameter or rules on elements in your profile.

In FHIR, two path expression languages are used to navigate through resources and their elements. The first one is XPath, a XML path language to select nodes in a XML document. The adoption of this language is low, however, the main reasons being that it is XML specific and not well adopted. The second one is FHIRPath, a path based navigation and extraction language, that is similar to XPath, but designed specifically for FHIR. Operations are expressed in terms of the logical content of hierarchical data models, and support traversal, selection, and filtering of data.

In this module we will focus mainly on FHIRPath and its use in profiling. We will start with a brief introduction into FHIRPath. In the next chapters you will learn how to create rules on elements called invariants and how to define element paths in search parameters.

2. FHIRPath

FHIRPath allows you to navigate through the element tree of a resource. For example, you can use the expression name.given to retrieve all values of the given element. Note that this expression will navigate through all name elements and result in a collection of all given elements present in each name element. It is not necessary to provide the root node in the expression (e.g. Patient.name.given). Both expressions will have the same outcome for Patient resources, but the latter will only return results when evaluated on resources of type Patient.

2.1 Output of a FHIRPath expression (collections)

Keep in mind that the result of a FHIRPath expression is always a collection, even if the returned value is a single item. This collection is ordered, non-unique, indexed and countable. These characteristics are explained below.

Type	Description
Ordered	The order of items is maintained as much as possible.
Non-unique	The collection may contain duplicate items. Although allowed, there are functions available to remove duplicates from the collection.
Indexed	The items in the collections are indexed starting by 0 for the first item, 1 for the second and so on.
Countable	It is possible to count the number of items in a collection using the function `count()`.

Note in FHIRPath there is no such a thing as a null value, instead if there's no data available this will result in an empty collection (represented as {}).

2.2 Symbols and operators

2.2.1 Symbols

The following symbols are allowed in a FHIRPath expression.

Symbol	Description	Example
()	Parentheses for delimiting groups within expressions	(name.given \| name.family)
[]	Brackets for indexing into lists and strings	name[0]
{}	Braces for delimiting lists	{value1, value2}
.	Period for qualifiers, accessors, and dot-invocation	name.given
,	Comma for delimiting items in a syntactic list	{value1, value2}
= != ~ !~ < > <= >=	Comparison operators for comparing values	name = "Chalmers"
+ - * /	Mathematical operators	1+3
&	String concatenation	name.given & " " & name.family

2.2.2 Logical operators

Below is a list of all basic logical operators that are supported in a FHIRPath expression.

Operator	Evaluation	Example
and	Returns true if both operands evaluate to true, false if one of the operands evaluates to false and an empty collection in all other cases	a and b
or	Returns false if both operands evaluate to false, true if one or both of the operands evaluate to true and an empty collection in all other cases	a or b
xor	Returns true if exactly one of the operands evaluates to true. Returns false if either both operands evaluate to true or both operands evaluate to false. Returns an empty collection in all other cases	a xor b
implies	Returns the boolean evaluation of the right operand if the left operand evaluates to true. Returns true if the left operand evaluates to false. Returns true if the right operand evaluates to true and the left operand is an empty collection. Returns the empty collection in all other cases	a implies b

2.2.3 Data type operators

As explained earlier, the root type is optional in a FHIRPath expression. In the same way you can either ignore the type of an element in your expression (resulting in a collection containing items of one or more data types) or filter the collection on type before navigating further down the tree (i.e. by using the ofType element). The following data type operators can be used to determine if an item is of a specific type or to treat an item as a specific type.

Operator	Evaluation	Example
is	Returns true if a single item in a collection is of a given data type and false if it isn't. Returns an error if the collection contains more than one item. In all other cases an empty collection is returned.	name.given is String
as	Treats an item as a specific type. Returns a single item in a collection if it is of the specified type and an empty collection otherwise. Returns an error when the collection contains more than one item or when a single item cannot be resolved to a valid type.	Observation.value as Quantity

2.2.4 Collection operators

Operator	Evaluation	Example
\|	Merges two collections into one single collection. When one of the collections is empty, the non-empty collection will be returned. Duplicate items are removed.	name.given\|name.family
in	Returns true if the left operand includes a single item that is also present in the right operand collection. Returns an empty collection if the left operand is empty. Returns an error if the left operand includes more than one item.	"Peter" in name.given
contains	This is the inverse operation of `in`, returning true if the left operand includes a single item present in the right operand.	name.given contains {"Peter","James"}

2.3 FHIRPath invocations

FHIRPath expressions may contain literals and/or function invocations.

2.3.1 Literals

The following literals are supported:

literal	values
boolean	true, false
string	'test string', 'urn:oid:3.4.5.6.7.8'
integer	0, 45
decimal	0.0, 3.141592653589793236
dateTime	@2015-02-04T14:34:28Z (`@` followed by ISO8601 compliant date/time)
time	@T14:34:28+09:00 (`@` followed by ISO8601 compliant time beginning with `T`)
quantity	10 'mg', 4 days

2.3.2 Functions

For a complete list of functions, visit the FHIRPath specification. Below is a list of examples of functions that are often used in FHIRPath expressions.

Function	Returns	Description
empty()	Boolean	Returns true if the collection is empty and false if it's not
not()	Boolean	Returns true if the collection evaluates to false and false if it evaluates to true. Returns an empty collection in all other cases
exists([expression])	Boolean	Returns false if the collection is empty and true if it's not. Optional criteria can be applied before evaluation, which would be equivalent to `(criteria).exists()`
first()	Collection	Returns the first item in a collection if non-empty and an empty collection otherwise. This function is equivalent to `item(0)`.
last()	Collection	Returns the last item in a collection if non-empty and an empty collection otherwise.
where(expression)	Collection	Returns the collection filtered based on the given criteria. Items that evaluate to true are included, while items that evaluate to false or empty are excluded.
iif(expression, true-result, [otherwise-result])	Collection	Returns the value of the true-result if the criterium is true and the value of the (optional) otherwise-result when the criterium is false or the collection is empty. If there's not otherwise-result, an empty collection is returned instead.
contains(string)	Boolean	Returns true if the given string is a substring of a single string item in a collection or when substring is an empty string.
combine(collection)	Collections	Combines the collection with the given collection without removing any duplicates.

3. Invariants

Invariants can be used to place additional constraints on elements based on XPath or FHIRPath expressions.

For example, say you want to make it mandatory to add a reason when a medication is not administered. You can't do so by changing the minimum cardinality of the reasonNotGiven element to 1, because the element is only mandatory when specific criteria are met. In this case, you could use the following expression:

notGiven implies reasonNotGiven.exists()

The first part of this expression is the boolean value of the notGiven element. The second part of the expression will only be evaluated when the value of this element is true. When the value of the notGiven element is false, the second part of the expression will not be evaluated and the entire expression will evaluate to true. When the notGiven element is empty, the expression will return an empty collection.

The second part of the expression returns true when the reasonNotGiven element has a value and false otherwise. So the meaning of this expression is that when the value of the notGiven element is true, the reasonNotGiven element should exist.

3.1 Adding a constraint to an ElementDefinition

The ElementDefinition has a child element called constraint that can be used to add expressions.

It is mandatory to provide a key, a severity (error or warning), a human description of the constraint and the actual FHIRPath expression. The corresponding XPath expression is optional.

Below is an example of what the XML code would look like when adding a constraint on the reasonNotGiven element as explained above.

<element id="MedicationAdministration.reasonNotGiven">
<path value="MedicationAdministration.reasonNotGiven"/>
<constraint>
<key value="ele-2"/>
<severity value="error"/>
<human value="If medication is not given the reason should be present"/>
<expression value="notGiven implies reasonNotGiven.exists()"/>
</constraint>
</element>

3.2 Adding constraints in Forge

When you want to add a constraint to an element using Forge, navigate down the element properties and click + next to Constraints. Add a Key and select a Severity (warning or error). In the Expression field add your FHIRPath expression. In the Description field add a human-readable description of your expression.

4. Element paths in search parameters

In a SearchParameter resource it is necessary to define the path to the element that is used to evaluate the search parameter against. You may either use the expression element to define a FHIRPath expression or the xpath element to define a XPath expression. Note that the xpathUsage element is required when the xpath element is used to indicate how the xpath statement should be interpreted.

Below is an example of a search parameter that can be used to filter on the clinical status of a Condition.

<SearchParameter xmlns="http://hl7.org/fhir">
  <id value="clinicalstatus" />
  <url value="http://hl7.org/fhir/SearchParameter/Condition-clinicalstatus" />
  <name value="clinicalstatus" />
  <status value="active" />
  <code value="clinicalstatus" />
  <base value="Condition" />
  <type value="token" />
  <description value="The clinical status of the condition" />
  <expression value="Condition.clinicalStatus" />
  <xpath value="f:Condition/f:clinicalStatus" />
  <xpathUsage value="normal" />
</SearchParameter>

Note that search parameters can be made more generic by leaving out the root type in the expression and selecting multiple resource types in the base value. When you want to apply your search parameter to all resource types, use Resource as the base value and the root type.

<base value="Resource" />
<type value="token" />
<description value="Logical id of this artifact" />
  <expression value="Resource.id" />
  <xpath value="f:Resource/f:id" />
  <xpathUsage value="normal" />
</SearchParameter>

Real-life examples

Data Access Framework (DAF)

The HL7 US Data Access Framework (DAF) Initiative aims to identify, test and validate standards required to access and extract data from internal and external health IT systems at a (inter)national level. DAF aims to provide standards that help users to access data across multiple systems and/or organizations.

Below are the details of the DAF-Pract profile on Practitioner. This profile has an invariant constraining the name and identifier elements in such a way that at least one one of them is mandatory. In other words, a Practitioner should have either a name, an identifier or both - see inv-1:

Practitioner(DAF-Pract)
Definition	This is basic constraint on provider for use in DAF resources.
Control	0..*
Type	Practitioner
Alternate Names	Provider
Comments	Note that a cab driver no longer fits the bill. You probably would be interested in the organization rather than the individual?
Invariants	Defined on this element inv-1: Shall havePractitioner.name and/or Practitioner.identifier. (xpath: exists(f:name) or exists(f:identifier))
Practitioner.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control	0..1
Type	id
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.
Practitioner.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Control	0..1
Type	Meta
Practitioner.implicitRules
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.
Control	0..1
Type	uri
Is Modifier	true
Comments	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 as much as possible.
Practitioner.language
Definition	The base language in which the resource is written.
Control	0..1
Binding	A human language. The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Type	code
Comments	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).
Practitioner.text
Definition	A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "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.
Control	1..1(See dom-1 for the conditions that apply
Type	Narrative
Must Support	true
Alternate Names	narrative, html, xhtml, display
Comments	Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.
Practitioner.text.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.text.status
Definition	The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.
Control	1..1
Binding	The status of a resource narrative The codes SHALL be taken from NarrativeStatus
Type	code
Must Support	true
Fixed Value	generated
Practitioner.text.div
Definition	The actual narrative content, a stripped down version of XHTML.
Control	1..1
Type	xhtml
Comments	The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content may not contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
Invariants	Defined on this element txt-1: The narrative SHALL contain only the basic html formatting elements described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (xpath: not(descendant-or-self::[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))])) txt-2: The narrative SHALL have some non-whitespace content (xpath: descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src]) txt-3: The narrative SHALL contain only the basic html formatting attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (xpath: not(descendant-or-self::/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))]))
Practitioner.contained
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.
Control	0..*
Type	Resource
Alternate Names	inline resources, anonymous resources, contained resources
Comments	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.
Practitioner.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.modifierExtension
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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control	0..*
Type	Extension
Is Modifier	true
Alternate Names	extensions, user content
Comments	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.
Practitioner.identifier
Definition	An identifier that applies to this person in this role.
Control	0..*
Type	Identifier
Must Support	true
Requirements	Either id or name is needed.
Practitioner.identifier.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.identifier.use
Definition	The purpose of this identifier.
Control	0..1
Binding	Identifies the purpose for this identifier, if known . The codes SHALL be taken from IdentifierUse
Type	code
Is Modifier	true
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Practitioner.identifier.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Control	0..1
Binding	A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
Type	CodeableConcept
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Practitioner.identifier.system
Definition	NPI could be used as the identifier system in the US.
Control	1..1
Type	uri
Must Support	true
Requirements	There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers.
Comments	NPI could be used as the identifier system in the US.
Example	NPI could be used as the identifier system in the US.
Practitioner.identifier.value
Definition	The portion of the identifier typically displayed to the user and which is unique within the context of the system.
Control	1..1
Type	string
Must Support	true
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.
Example	123456
Practitioner.identifier.period
Definition	Time period during which identifier is/was valid for use.
Control	0..1
Type	Period
Practitioner.identifier.assigner
Definition	Organization that issued/manages the identifier.
Control	0..1
Type	Reference(Organization)
Comments	The reference may be just a text description of the assigner.
Practitioner.active
Definition	Whether this practitioner's record is in active use.
Control	0..1
Type	boolean
Requirements	Need to be able to mark a practitioner record as not to be used because it was created in error.
Comments	Default is true. If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.
Default Value	true
Practitioner.name
Definition	A name associated with the person.
Control	0..1
Type	HumanName
Must Support	true
Requirements	Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.
Practitioner.name.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.name.use
Definition	Identifies the purpose for this name.
Control	0..1
Binding	The use of a human name The codes SHALL be taken from NameUse
Type	code
Is Modifier	true
Requirements	Allows the appropriate name for a particular context of use to be selected from among a set of names.
Comments	This is labeled as "Is Modifier" because applications should not mistake a temporary or old name etc.for a current/permanent one. Applications can assume that a name is current unless it explicitly says that it is temporary or old.
Practitioner.name.text
Definition	A full text representation of the name.
Control	0..1
Type	string
Requirements	A renderable, unencoded form.
Comments	Can provide both a text representation and structured parts.
Practitioner.name.family
Definition	The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.
Control	1..*
Type	string
Must Support	true
Alternate Names	surname
Comments	For family name, hyphenated names such as "Smith-Jones" are a single name, but names with spaces such as "Smith Jones" are broken into multiple parts.
Practitioner.name.given
Definition	Given name.
Control	0..2
Type	string
Must Support	true
Alternate Names	first name, middle name
Comments	Can be first and middle name or initial.
Practitioner.name.prefix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name.
Control	0..1
Type	string
Must Support	true
Practitioner.name.suffix
Definition	Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.
Control	0..1
Type	string
Must Support	true
Practitioner.name.period
Definition	Indicates the period of time when this name was valid for the named person.
Control	0..1
Type	Period
Requirements	Allows names to be placed in historical context.
Practitioner.telecom
Definition	A contact detail for the practitioner, e.g. a telephone number or an email address.
Control	0..*
Type	ContactPoint
Must Support	true
Requirements	Need to know how to reach a practitioner.
Comments	Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Practitioner.telecom.extension(directAddressInd)
Definition	An Extension
Control	0..*
Type	Extension(us-core-direct)
Must Support	true
Practitioner.telecom.system
Definition	Telecommunications form for contact point - what communications system is required to make use of the contact.
Control	1..1(See cpt-2 for the conditions that apply
Binding	Telecommunications form for contact point The codes SHALL be taken from ContactPointSystem
Type	code
Must Support	true
Practitioner.telecom.value
Definition	The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Control	1..1
Type	string
Must Support	true
Requirements	Need to support legacy numbers that are not in a tightly controlled format.
Comments	Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.
Practitioner.telecom.use
Definition	Identifies the purpose for the contact point.
Control	0..1
Binding	Use of contact point The codes SHALL be taken from ContactPointUse
Type	code
Is Modifier	true
Requirements	Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.
Comments	This is labeled as "Is Modifier" because applications should not mistake a temporary or old contact etc.for a current/permanent one. Applications can assume that a contact is current unless it explicitly says that it is temporary or old.
Practitioner.telecom.rank
Definition	Specifies a preferred order in which to use a set of contacts. Contacts are ranked with lower values coming before higher values.
Control	0..1
Type	positiveInt
Comments	Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
Practitioner.telecom.period
Definition	Time period when the contact point was/is in use.
Control	0..1
Type	Period
Practitioner.address
Definition	The postal address where the practitioner can be found or visited or to which mail can be delivered.
Control	0..*
Type	Address
Requirements	Need to keep track where the practitioner can found during work or for directing mail.
Practitioner.gender
Definition	Administrative Gender - the gender that the person is considered to have for administration and record keeping purposes.
Control	0..1
Binding	The gender of a person used for administrative purposes. The codes SHALL be taken from AdministrativeGender
Type	code
Requirements	Needed to address the person correctly.
Practitioner.birthDate
Definition	The date of birth for the practitioner.
Control	0..1
Type	date
Requirements	Needed for identification.
Practitioner.photo
Definition	Image of the person.
Control	0..*
Type	Attachment
Requirements	Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.
Practitioner.practitionerRole
Definition	The list of roles/organizations that the practitioner is associated with.
Control	0..*
Type	BackboneElement
Must Support	true
Practitioner.practitionerRole.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.practitionerRole.modifierExtension
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control	0..*
Type	Extension
Is Modifier	true
Alternate Names	extensions, user content, modifiers
Comments	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.
Practitioner.practitionerRole.managingOrganization
Definition	The organization where the Practitioner performs the roles associated.
Control	0..1
Type	Reference(daf-organization)
Must Support	true
Practitioner.practitionerRole.role
Definition	Roles which this practitioner is authorized to perform for the organization.
Control	0..1
Binding	The role a person plays representing an organization For example codes, see PractitionerRole
Type	CodeableConcept
Requirements	Need to know what authority the practitioner has - what can they do?
Comments	A person may have more than one role. At least one role is required.
Practitioner.practitionerRole.specialty
Definition	Specific specialty of the practitioner.
Control	0..*
Binding	Specific specialty associated with the agency For example codes, see PractitionerSpecialty
Type	CodeableConcept
Practitioner.practitionerRole.period
Definition	The period during which the person is authorized to act as a practitioner in these role(s) for the organization.
Control	0..1
Type	Period
Requirements	Even after the agencies is revoked, the fact that it existed must still be recorded.
Practitioner.practitionerRole.location
Definition	The location(s) at which this practitioner provides care.
Control	0..*
Type	Reference(Location)
Practitioner.practitionerRole.healthcareService
Definition	The list of healthcare services that this worker provides for this role's Organization/Location(s).
Control	0..*
Type	Reference(HealthcareService)
Practitioner.qualification
Definition	Qualifications obtained by training and certification.
Control	0..*
Type	BackboneElement
Practitioner.qualification.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control	0..*
Type	Extension
Alternate Names	extensions, user content
Comments	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.
Practitioner.qualification.modifierExtension
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control	0..*
Type	Extension
Is Modifier	true
Alternate Names	extensions, user content, modifiers
Comments	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.
Practitioner.qualification.identifier
Definition	An identifier that applies to this person's qualification in this role.
Control	0..*
Type	Identifier
Requirements	Often, specific identities are assigned for the qualification.
Practitioner.qualification.code
Definition	Coded representation of the qualification.
Control	1..1
Binding	Specific qualification the practitioner has to provide a service For example codes, see ANZSCO -- Australian and New Zealand Standard Classification of Occupations, 2013, Version 1.2
Type	CodeableConcept
Practitioner.qualification.period
Definition	Period during which the qualification is valid.
Control	0..1
Type	Period
Requirements	Qualifications are often for a limited period of time, and can be revoked.
Practitioner.qualification.issuer
Definition	Organization that regulates and issues the qualification.
Control	0..1
Type	Reference(Organization)
Practitioner.communication
Definition	A language the practitioner is able to use in patient communication.
Control	0..*
Binding	A human language. The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Type	CodeableConcept
Requirements	Knowing which language a practitioner speaks can help in facilitating communication with patients.
Comments	The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Note that this is a DSTU2 project and so the XPath expression is given in the Practitioner element instead of a FHIRPath expression: exists(f:name) or exists(f:identifier). In DSTU2 the Xpath expression is mandatory and it is not possible to provide a FHIRPath expression. However, in STU3 a FHIRPath expression is mandatory, while the XPath expression is optional - in FHIRPath the same expression would be: name.exists() or identifier.exists()

Core StructureDefinitions STU3

This project on Simplifier contains all STU3 structure definitions that are part of the core specification. For example, there are some core VitalSigns profiles based on Observation. Below are the details of the core profile for bodyheight. The first couple of invariants (dom-1 to dom-4) in this profile are common rules for contained resources that apply to all resources. Next, there are two rules concerning the Observation resource (there can only be a data absent reason when there is no value and the value associated with a code shall be empty when the code is the same as one of the component codes). Last, there is a specific rule for the vital signs profile, which says that either a value or data absent reason shall be present when both the component and related element are missing.

In addition, there are some invariants defined on specific elements. For example, take a look at the category element. This constraint says that the category 'vital-signs' and the code system 'http://hl7.org/fhir/observation-category' should be present.

Observation
Definition	This profile defines how to represent Body Height observations in FHIR using a standard LOINC code and UCUM units of measure.
Cardinality	0...*
Alias	Vital Signs, Measurement, Results, Tests
Comments	Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc.
Invariants	dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` obs-7:If code is the same as a component code then the value element associated with the code SHALL NOT be present `value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()` obs-6:dataAbsentReason SHALL only be present if Observation.value[x] is not present `dataAbsentReason.empty() or value.empty()` vs-2:If there is no component or related element then either a value[x] or a data absent reason must be present `(component.empty() and related.empty()) implies (dataAbsentReason.exists() or value.exists())`
Mappings	rim:Entity. Role, or Act workflow:Event sct-concept:< 363787002 \|Observable entity\| v2:OBX rim:Observation[classCode=OBS, moodCode=EVN] w5:clinical.diagnostics
Observation.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	id
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a rim:N/A
Observation.implicitRules
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.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. languages (extensible)
Comments	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).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.text
Definition	A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 in formation is added later.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a rim:N/A rim:Act.text?
Observation.contained
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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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.
Mappings	rim:Entity. Role, or Act rim:N/A
Observation.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.modifierExtension
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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.identifier
Definition	A unique identifier assigned to this observation.
Cardinality	0...*
Type	Identifier
Summary	True
Requirements	Allows observations to be distinguished and referenced.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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] servd:Identifier workflow:Event.identifier v2: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. rim:id w5:id
Observation.basedOn
Definition	A plan, proposal or order that is fulfilled in whole or in part by this event.
Cardinality	0...*
Type	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ProcedureRequest \| ReferralRequest)
Summary	True
Alias	Fulfills
Requirements	Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn v2:ORC rim:.outboundRelationship[typeCode=FLFS].target
Observation.status
Definition	The status of the result value.
Cardinality	1...1
Type	code
Binding	Codes providing the status of an observation. observation-status (required)
Must Support	True
Modifier	True
Summary	True
Requirements	Need to track the status of individual results. Some results are finalized before the whole report is finalized.
Comments	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a workflow:Event.status sct-concept:< 445584004 \|Report by finality status\| v2:OBX-11 rim:status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise" w5:status
Observation.category
Definition	A code that classifies the general type of observation being made.
Cardinality	1...*
Type	CodeableConcept
Binding	Codes for high level observation categories. observation-category (preferred)
Must Support	True
Requirements	Used for filtering what observations are retrieved and displayed.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` vs-4:Must have a category of 'vital-signs' and a code system 'http://hl7.org/fhir/observation-category' `where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='vital-signs').exists()`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code w5:class
Observation.code
Definition	Body Height.
Cardinality	1...1
Type	CodeableConcept
Binding	This identifies the vital sign result type. observation-vitalsignresult (extensible)
Must Support	True
Summary	True
Alias	Name, Test
Requirements	SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).
Comments	additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code sct-concept:< 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2:OBX-3 rim:code sct-attr:116680003 \|Is a\| w5:what
Observation.code.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.code.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.code.coding
Definition	A reference to a code defined by a terminology system.
Cardinality	0...*
Type	Coding
Summary	True
Requirements	Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Slicing	Unordered, Open, by code(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Observation.code.coding:bodyheightcode
Definition	A reference to a code defined by a terminology system.
Cardinality	0...*
Type	Coding
Summary	True
Requirements	Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Comments	Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Observation.code.coding:BodyHeightCode.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.code.coding:BodyHeightCode.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.code.coding:bodyheightcode.system
Definition	The identification of the code system that defines the meaning of the symbol in the code.
Cardinality	0...1
Type	uri
Summary	True
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Comments	The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Fixed Value	http://loinc.org
Mappings	rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
Observation.code.coding:BodyHeightCode.version
Definition	The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Cardinality	0...1
Type	string
Summary	True
Comments	Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
Observation.code.coding:bodyheightcode.code
Definition	A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Cardinality	0...1
Type	code
Summary	True
Requirements	Need to refer to a particular code in the system.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Fixed Value	8302-2
Mappings	rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
Observation.code.coding:BodyHeightCode.display
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Cardinality	0...1
Type	string
Summary	True
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
Observation.code.coding:BodyHeightCode.userSelected
Definition	Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
Cardinality	0...1
Type	boolean
Summary	True
Requirements	This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Comments	Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Observation.code.text
Definition	A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality	0...1
Type	string
Summary	True
Requirements	The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments	Very often the text is the same as a displayName of one of the codings.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
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.
Cardinality	1...1
Type	Reference(Patient)
Must Support	True
Summary	True
Requirements	Observations have no value if you don't know who or what they're about.
Comments	One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject v2:PID-3 rim:participation[typeCode=SBJ] w5:who.focus
Observation.context
Definition	The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Cardinality	0...1
Type	Reference(Encounter \| EpisodeOfCare)
Alias	Encounter
Requirements	For some observations it may be important to know the link between an observation and a particular encounter.
Comments	This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.context v2:PV1 rim:inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN] w5:context
Observation.effective[x]
Definition	Often just a dateTime for Vital Signs.
Cardinality	1...1
Type	dateTime, Period
Must Support	True
Summary	True
Alias	Occurrence
Requirements	Knowing when an observation was deemed true is important to its relevance as well as determining trends.
Comments	At least a date should be present unless this observation is a historical report.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` vs-1:Datetime must be at least to day. `($this as dateTime).toString().length() >= 8`
Mappings	rim:n/a workflow:Event.occurrence[x] v2:OBX-14, and/or OBX-19 after v2.4 (depends on who observation made) rim:effectiveTime w5:when.done
Observation.issued
Definition	The date and time this observation was made available to providers, typically after the results have been reviewed and verified.
Cardinality	0...1
Type	instant
Summary	True
Comments	Updated when the result is updated.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made) rim:participation[typeCode=AUT].time w5:when.recorded
Observation.performer
Definition	Who was responsible for asserting the observed value as "true".
Cardinality	0...*
Type	Reference(Practitioner \| Organization \| Patient \| RelatedPerson)
Summary	True
Requirements	May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer v2: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' rim:participation[typeCode=PRF] w5:who.actor
Observation.valueQuantity
Definition	Vital Sign Value recorded with UCUM.
Cardinality	0...1
Type	Quantity
Binding	Common UCUM units for recording Vital Signs ucum-vitals-common (required)
Must Support	True
Summary	True
Requirements	SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
Comments	Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3:If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()`
Mappings	rim:n/a v2:SN (see also Range) or CQ rim:PQ, IVL<PQ>, MO, CO, depending on the values workflow:Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason) sct-concept:< 441742003 \|Evaluation finding\| v2:OBX.2, OBX.5, OBX.6 rim:value sct-attr:363714003 \|Interprets\|
Observation.value[x].id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.value[x].extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.value[x].value
Definition	The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Cardinality	1...1
Type	decimal
Must Support	True
Summary	True
Requirements	Precision is handled implicitly in almost all cases of measurement.
Comments	The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:SN.2 / CQ - N/A rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
Observation.value[x].comparator
Definition	How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Cardinality	0...1
Type	code
Binding	How the Quantity should be understood and represented. quantity-comparator (required)
Modifier	True
Summary	True
Requirements	Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Comments	This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:SN.1 / CQ.1 rim:IVL properties
Observation.value[x].unit
Definition	A human-readable form of the unit.
Cardinality	1...1
Type	string
Must Support	True
Summary	True
Requirements	There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:PQ.unit
Observation.value[x].system
Definition	The identification of the system that provides the coded form of the unit.
Cardinality	1...1
Type	uri
Must Support	True
Summary	True
Requirements	Need to know the system that defines the coded form of the unit.
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Fixed Value	http://unitsofmeasure.org
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:CO.codeSystem, PQ.translation.codeSystem
Observation.valueQuantity.code
Definition	Coded responses from the common UCUM units for vital signs value set.
Cardinality	1...1
Type	code
Binding	Common UCUM units for Body Length measures such as Body Height and Head Circumference ucum-bodylength (required)
Must Support	True
Summary	True
Requirements	Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
Comments	The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:PQ.code, MO.currency, PQ.translation.code
Observation.dataAbsentReason
Definition	Provides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes specifying why the result (Observation.value[x]) is missing. observation-valueabsentreason (extensible)
Must Support	True
Requirements	For many results it is necessary to handle exceptional values in measurements.
Comments	Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason) v2:N/A rim:value.nullFlavor
Observation.interpretation
Definition	The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes identifying interpretations of observations. observation-interpretation (extensible)
Alias	Abnormal Flag
Requirements	For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 260245000 \|Findings values\| v2:OBX-8 rim:interpretationCode sct-attr:363713009 \|Has interpretation\|
Observation.comment
Definition	May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result.
Cardinality	0...1
Type	string
Requirements	Need to be able to provide free text additional information.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a workflow:Event.note v2:NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX) rim:subjectOf.observationEvent[code="annotation"].value
Observation.bodySite
Definition	Indicates the site on the subject's body where the observation was made (i.e. the target site).
Cardinality	0...1
Type	CodeableConcept
Binding	Codes describing anatomical locations. May include laterality. body-site (example)
Comments	Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 123037004 \|Body structure\| v2:OBX-20 rim:targetSiteCode sct-attr:718497002 \|Inherent location\|
Observation.method
Definition	Indicates the mechanism used to perform the observation.
Cardinality	0...1
Type	CodeableConcept
Binding	Methods for simple observations. observation-methods (example)
Requirements	In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
Comments	Only used if not implicit in code for Observation.code.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:OBX-17 rim:methodCode
Observation.specimen
Definition	The specimen that was used when this observation was made.
Cardinality	0...1
Type	Reference(Specimen)
Comments	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).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) sct-concept:< 123038009 \|Specimen\| v2:SPM segment rim:participation[typeCode=SPC].specimen sct-attr:704319004 \|Inherent in\|
Observation.device
Definition	The device used to generate the observation data.
Cardinality	0...1
Type	Reference(Device \| DeviceMetric)
Comments	An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) sct-concept:< 49062001 \|Device\| v2:OBX-17 / PRT -10 rim:participation[typeCode=DEV] sct-attr:424226004 \|Using device\|
Observation.referenceRange
Definition	Guidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality	0...*
Type	BackboneElement
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.
Comments	Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` obs-3:Must have at least a low or a high or text `low.exists() or high.exists() or text.exists()`
Mappings	rim:n/a v2:OBX.7 rim:outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
Observation.referenceRange.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.referenceRange.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.referenceRange.modifierExtension
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.referenceRange.low
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).
Cardinality	0...1
Type	SimpleQuantity
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3:If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1:The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim:n/a v2:SN (see also Range) or CQ rim:PQ, IVL<PQ>, MO, CO, depending on the values v2:OBX-7 rim:value:IVL_PQ.low
Observation.referenceRange.high
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).
Cardinality	0...1
Type	SimpleQuantity
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3:If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1:The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim:n/a v2:SN (see also Range) or CQ rim:PQ, IVL<PQ>, MO, CO, depending on the values v2:OBX-7 rim:value:IVL_PQ.high
Observation.referenceRange.type
Definition	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Cardinality	0...1
Type	CodeableConcept
Binding	Code for the meaning of a reference range. referencerange-meaning (extensible)
Requirements	Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation.
Comments	This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2:OBX-10 rim:interpretationCode
Observation.referenceRange.appliesTo
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.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes identifying the population the reference range applies to. referencerange-appliesto (example)
Requirements	Need to be able to identify the target population for proper interpretation.
Comments	This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2:OBX-10 rim:interpretationCode
Observation.referenceRange.age
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.
Cardinality	0...1
Type	Range
Requirements	Some analytes vary greatly over age.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` rng-2:If present, low SHALL have a lower value than high `low.empty() or high.empty() or (low <= high)`
Mappings	rim:n/a v2:NR and also possibly SN (but see also quantity) rim:IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]> rim:outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
Observation.referenceRange.text
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'.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:OBX-7 rim:value:ST
Observation.related
Definition	Used when reporting vital signs panel components.
Cardinality	0...*
Type	BackboneElement
Must Support	True
Summary	True
Requirements	Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.
Comments	For a discussion on the ways Observations can assembled in groups together see Notes below.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:Relationships established by OBX-4 usage rim:outBoundRelationship
Observation.related.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.related.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.related.modifierExtension
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.related.type
Definition	A code specifying the kind of relationship that exists with the target resource.
Cardinality	1...1
Type	code
Binding	Codes specifying how two observations are related. observation-relationshiptypes (required)
Must Support	True
Requirements	A relationship type SHOULD be provided.
Comments	The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Fixed Value	has-member
Mappings	rim:n/a v2:N/A rim:.typeCode
Observation.related.target
Definition	A reference to the observation or [QuestionnaireResponse](questionnaireresponse.html#) resource that is related to this observation.
Cardinality	1...1
Type	Reference(VitalSigns)
Must Support	True
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim:.targetObservation
Observation.component
Definition	Used when reporting systolic and diastolic blood pressure.
Cardinality	0...*
Type	BackboneElement
Must Support	True
Summary	True
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.
Comments	For a discussion on the ways Observations can be assembled in groups together see Notes below.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` vs-3:If there is no a value a data absent reason must be present `value.exists() or dataAbsentReason.exists()`
Mappings	rim:n/a v2:containment by OBX-4? rim:outBoundRelationship[typeCode=COMP]
Observation.component.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.component.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.component.modifierExtension
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.component.code
Definition	Describes what was observed. Sometimes this is called the observation "code".
Cardinality	1...1
Type	CodeableConcept
Binding	This identifies the vital sign result type. observation-vitalsignresult (extensible)
Must Support	True
Summary	True
Requirements	Knowing what kind of observation is being made is essential to understanding the observation.
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2:OBX-3 rim:code w5:what
Observation.component.value[x]
Definition	Vital Sign Value recorded with UCUM.
Cardinality	0...1
Type	Quantity
Binding	Common UCUM units for recording Vital Signs ucum-vitals-common (required)
Must Support	True
Summary	True
Requirements	SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).
Comments	Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from http://hl7.org/fhir/ValueSet/v2-0136 (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3:If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()`
Mappings	rim:n/a v2:SN (see also Range) or CQ rim:PQ, IVL<PQ>, MO, CO, depending on the values sct-concept:363714003 \|Interprets\| < 441742003 \|Evaluation finding\| v2:OBX.2, OBX.5, OBX.6 rim:value sct-attr:363714003 \|Interprets\|
Observation.component.value[x].id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a
Observation.component.value[x].extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
Observation.component.value[x].value
Definition	The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Cardinality	1...1
Type	decimal
Must Support	True
Summary	True
Requirements	Precision is handled implicitly in almost all cases of measurement.
Comments	The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:SN.2 / CQ - N/A rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
Observation.component.value[x].comparator
Definition	How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Cardinality	0...1
Type	code
Binding	How the Quantity should be understood and represented. quantity-comparator (required)
Modifier	True
Summary	True
Requirements	Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Comments	This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:SN.1 / CQ.1 rim:IVL properties
Observation.component.value[x].unit
Definition	A human-readable form of the unit.
Cardinality	1...1
Type	string
Must Support	True
Summary	True
Requirements	There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:PQ.unit
Observation.component.value[x].system
Definition	The identification of the system that provides the coded form of the unit.
Cardinality	1...1
Type	uri
Must Support	True
Summary	True
Requirements	Need to know the system that defines the coded form of the unit.
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Fixed Value	http://unitsofmeasure.org
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:CO.codeSystem, PQ.translation.codeSystem
Observation.component.value[x].code
Definition	Coded responses from the common UCUM units for vital signs value set.
Cardinality	1...1
Type	code
Must Support	True
Summary	True
Requirements	Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
Comments	The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:(see OBX.6 etc.) / CQ.2 rim:PQ.code, MO.currency, PQ.translation.code
Observation.component.dataAbsentReason
Definition	Provides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes specifying why the result (Observation.value[x]) is missing. observation-valueabsentreason (extensible)
Must Support	True
Requirements	For many results it is necessary to handle exceptional values in measurements.
Comments	"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:N/A rim:value.nullFlavor
Observation.component.interpretation
Definition	The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes identifying interpretations of observations. observation-interpretation (extensible)
Alias	Abnormal Flag
Requirements	For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments	The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept:< 260245000 \|Findings values\| v2:OBX-8 rim:interpretationCode sct-attr:363713009 \|Has interpretation\|
Observation.component.referenceRange
Definition	Guidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality	0...*
Type	see (referenceRange)
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.
Comments	Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Mappings	v2:OBX.7 rim:outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

Below is the XML code of this profile. Scroll down to view the FHIRPath expressions for these constraints.

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="bodyheight" />
    <text>
        <status value="generated" />
        --- We have skipped the narrative for better readability of the resource ---
    </text>
    <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
        <valueMarkdown value="####Complete Summary of the Mandatory Requirements\n\n1.  One code in `Observation.code` which must have\n    -   a fixed `Observation.code.coding.system`=**&#39;http ://loinc.org&#39;**\n    -   a fixed  `Observation.code.coding.code`= **&#39;8302-2&#39;**\n    -   Other additional codes are allowed - e.g. more specific LOINC\n        Codes, SNOMED CT concepts, system specific codes. All codes\n        SHALL have an system value\n2.  a fixed`Observation.valueQuantity.code` = **&#39;cm&#39;, or &#39;[in_i]&#39;**" />
    </extension>
    <url value="http://hl7.org/fhir/StructureDefinition/bodyheight" />
    <name value="Vital Signs Profile" />
    <title value="VitalSigns" />
    <status value="draft" />
    <experimental value="false" />
    <publisher value="Health Level Seven International (Orders and Observations Workgroup)" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="http://www.hl7.org/Special/committees/orders/index.cfm Orders and Observations" />
        </telecom>
    </contact>
    <description value="FHIR Body Height Profile" />
    <fhirVersion value="3.0.0" />
    <mapping>
        <identity value="workflow" />
        <uri value="http://hl7.org/fhir/workflow" />
        <name value="Workflow Mapping" />
    </mapping>
    <mapping>
        <identity value="sct-concept" />
        <uri value="http://snomed.info/conceptdomain" />
        <name value="SNOMED CT Concept Domain Binding" />
    </mapping>
    <mapping>
        <identity value="v2" />
        <uri value="http://hl7.org/v2" />
        <name value="HL7 v2 Mapping" />
    </mapping>
    <mapping>
        <identity value="rim" />
        <uri value="http://hl7.org/v3" />
        <name value="RIM Mapping" />
    </mapping>
    <mapping>
        <identity value="w5" />
        <uri value="http://hl7.org/fhir/w5" />
        <name value="W5 Mapping" />
    </mapping>
    <mapping>
        <identity value="sct-attr" />
        <uri value="http://snomed.info/sct" />
        <name value="SNOMED CT Attribute Binding" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="Observation" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/vitalsigns" />
    <derivation value="constraint" />
    <snapshot>
        <element id="Observation">
            <path value="Observation" />
            <short value="FHIR Body Height Profile" />
            <definition value="This profile defines  how to represent Body Height observations in FHIR using a standard LOINC code and UCUM units of measure." />
            <comment value="Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc.  Other resources are used to provide context for observations such as lab reports, etc." />
            <alias value="Vital Signs" />
            <alias value="Measurement" />
            <alias value="Results" />
            <alias value="Tests" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation" />
                <min value="0" />
                <max value="*" />
            </base>
            <constraint>
                <key value="dom-2" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
                <expression value="contained.contained.empty()" />
                <xpath value="not(parent::f:contained and f:contained)" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-1" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL NOT contain any narrative" />
                <expression value="contained.text.empty()" />
                <xpath value="not(parent::f:contained and f:text)" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-4" />
                <severity value="error" />
                <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
                <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
                <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="dom-3" />
                <severity value="error" />
                <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource" />
                <expression value="contained.where((&#39;#&#39;+id in %resource.descendants().reference).not()).empty()" />
                <xpath value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat(&#39;#&#39;, $id))]))" />
                <source value="DomainResource" />
            </constraint>
            <constraint>
                <key value="obs-7" />
                <severity value="error" />
                <human value="If code is the same as a component code then the value element associated with the code SHALL NOT be present" />
                <expression value="value.empty() or code!=component.code" />
                <xpath value="not(exists(f:*[starts-with(local-name(.), &#39;value&#39;)])) or not(count(for $coding in f:code/f:coding return parent::*/f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value and f:system/@value=$coding/f:system/@value])=0)" />
                <source value="Observation" />
            </constraint>
            <constraint>
                <key value="obs-6" />
                <severity value="error" />
                <human value="dataAbsentReason SHALL only be present if Observation.value[x] is not present" />
                <expression value="dataAbsentReason.empty() or value.empty()" />
                <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), &#39;value&#39;)])))" />
                <source value="Observation" />
            </constraint>
            <constraint>
                <key value="vs-2" />
                <severity value="error" />
                <human value="If there is no component or related element then either a value[x] or a data absent reason must be present" />
                <expression value="(component.empty() and related.empty()) implies (dataAbsentReason or value)" />
                <xpath value="exists(f:component) or exists(f:related) or exists(f:*[starts-with(local-name(.), &#39;value&#39;)]) or exists(f:dataAbsentReason)" />
                <source value="Observation" />
            </constraint>
            <mapping>
                <identity value="rim" />
                <map value="Entity. Role, or Act" />
            </mapping>
            <mapping>
                <identity value="workflow" />
                <map value="Event" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 363787002 |Observable entity|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="Observation[classCode=OBS, moodCode=EVN]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="clinical.diagnostics" />
            </mapping>
        </element>
        <element id="Observation.id">
            <path value="Observation.id" />
            <short value="Logical id of this artifact" />
            <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
            <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="id" />
            </type>
            <isSummary value="true" />
        </element>
        <element id="Observation.meta">
            <path value="Observation.meta" />
            <short value="Metadata about the resource" />
            <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.meta" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Meta" />
            </type>
            <isSummary value="true" />
        </element>
        <element id="Observation.implicitRules">
            <path value="Observation.implicitRules" />
            <short value="A set of rules under which this content was created" />
            <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content." />
            <comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.implicitRules" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
        </element>
        <element id="Observation.language">
            <path value="Observation.language" />
            <short value="Language of the resource content" />
            <definition value="The base language in which the resource is written." />
            <comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource  Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Resource.language" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
                    <valueReference>
                        <reference value="http://hl7.org/fhir/ValueSet/all-languages" />
                    </valueReference>
                </extension>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="Language" />
                </extension>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
                    <valueBoolean value="true" />
                </extension>
                <strength value="extensible" />
                <description value="A human language." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/languages" />
                </valueSetReference>
            </binding>
        </element>
        <element id="Observation.text">
            <path value="Observation.text" />
            <short value="Text summary of the resource, for human interpretation" />
            <definition value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." />
            <comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded in formation is added later." />
            <alias value="narrative" />
            <alias value="html" />
            <alias value="xhtml" />
            <alias value="display" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="DomainResource.text" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Narrative" />
            </type>
            <condition value="dom-1" />
            <mapping>
                <identity value="rim" />
                <map value="Act.text?" />
            </mapping>
        </element>
        <element id="Observation.contained">
            <path value="Observation.contained" />
            <short value="Contained, inline Resources" />
            <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope." />
            <comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again." />
            <alias value="inline resources" />
            <alias value="anonymous resources" />
            <alias value="contained resources" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.contained" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Resource" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.extension">
            <path value="Observation.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.modifierExtension">
            <path value="Observation.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="DomainResource.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.identifier">
            <path value="Observation.identifier" />
            <short value="Business Identifier for observation" />
            <definition value="A unique identifier assigned to this observation." />
            <requirements value="Allows observations to be distinguished and referenced." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.identifier" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Identifier" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.identifier" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX.21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4." />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="id" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="id" />
            </mapping>
        </element>
        <element id="Observation.basedOn">
            <path value="Observation.basedOn" />
            <short value="Fulfills plan, proposal or order" />
            <definition value="A plan, proposal or order that is fulfilled in whole or in part by this event." />
            <requirements value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon." />
            <alias value="Fulfills" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.basedOn" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ProcedureRequest" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/ReferralRequest" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.basedOn" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="ORC" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value=".outboundRelationship[typeCode=FLFS].target" />
            </mapping>
        </element>
        <element id="Observation.status">
            <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
                <valueString value="default: final" />
            </extension>
            <path value="Observation.status" />
            <short value="registered | preliminary | final | amended +" />
            <definition value="The status of the result value." />
            <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." />
            <requirements value="Need to track the status of individual results. Some results are finalized before the whole report is finalized." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.status" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <mustSupport value="true" />
            <isModifier value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="Status" />
                </extension>
                <strength value="required" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-status" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.status" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 445584004 |Report by finality status|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-11" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct event with a type of &quot;revise&quot;" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="status" />
            </mapping>
        </element>
        <element id="Observation.category">
            <path value="Observation.category" />
            <short value="Classification of  type of observation" />
            <definition value="A code that classifies the general type of observation being made." />
            <comment value="In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once.  The level of granularity is defined by the category concepts in the value set." />
            <requirements value="Used for filtering what observations are retrieved and displayed." />
            <min value="1" />
            <max value="*" />
            <base>
                <path value="Observation.category" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <constraint>
                <key value="vs-4" />
                <severity value="error" />
                <human value="Must have a category of &#39;vital-signs&#39; and a code system &#39;http://hl7.org/fhir/observation-category&#39;" />
                <expression value="where(coding.system=&#39;http://hl7.org/fhir/observation-category&#39; and coding.code=&#39;vital-signs&#39;).exists()" />
                <xpath value="exists(f:coding/code[@value=&#39;vital-signs&#39;]) and exists(f:coding/system[@value=&#39;http://hl7.org/fhir/observation-category&#39;])" />
            </constraint>
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationCategory" />
                </extension>
                <strength value="preferred" />
                <description value="Codes for high level observation categories." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-category" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="rim" />
                <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="class" />
            </mapping>
        </element>
        <element id="Observation.code">
            <path value="Observation.code" />
            <short value="Body Height" />
            <definition value="Body Height." />
            <comment value="additional codes that translate or map to this code are allowed.  For example a more granular LOINC code or code that is used locally in a system." />
            <requirements value="5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301)." />
            <alias value="Name" />
            <alias value="Test" />
            <alias value="Name" />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.code" />
                <min value="1" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSigns" />
                </extension>
                <strength value="extensible" />
                <description value="This identifies the vital sign result type." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-vitalsignresult" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.code" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="code" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="116680003 |Is a|" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="what" />
            </mapping>
        </element>
        <element id="Observation.code.id">
            <path value="Observation.code.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.extension">
            <path value="Observation.code.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding">
            <path value="Observation.code.coding" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="code" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <short value="Code defined by a terminology system" />
            <definition value="A reference to a code defined by a terminology system." />
            <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true." />
            <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="CodeableConcept.coding" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Coding" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1-8, C*E.10-22" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="union(., ./translation)" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode">
            <path value="Observation.code.coding" />
            <sliceName value="BodyHeightCode" />
            <short value="Code defined by a terminology system" />
            <definition value="A reference to a code defined by a terminology system." />
            <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true." />
            <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="CodeableConcept.coding" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Coding" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1-8, C*E.10-22" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="union(., ./translation)" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.id">
            <path value="Observation.code.coding.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.extension">
            <path value="Observation.code.coding.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.system">
            <path value="Observation.code.coding.system" />
            <short value="Identity of the terminology system" />
            <definition value="The identification of the code system that defines the meaning of the symbol in the code." />
            <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7&#39;s list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously." />
            <requirements value="Need to be unambiguous about the source of the definition of the symbol." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.system" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://loinc.org" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./codeSystem" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.version">
            <path value="Observation.code.coding.version" />
            <short value="Version of the system - if relevant" />
            <definition value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged." />
            <comment value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.version" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./codeSystemVersion" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.code">
            <path value="Observation.code.coding.code" />
            <short value="Symbol in syntax defined by the system" />
            <definition value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)." />
            <requirements value="Need to refer to a particular code in the system." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.code" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <fixedCode value="8302-2" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./code" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.display">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.code.coding.display" />
            <short value="Representation defined by the system" />
            <definition value="A representation of the meaning of the code in the system, following the rules of the system." />
            <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know  the system." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.display" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.2 - but note this is not well followed" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CV.displayName" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" />
            </mapping>
        </element>
        <element id="Observation.code.coding:bodyheightcode.userSelected">
            <path value="Observation.code.coding.userSelected" />
            <short value="If this coding was chosen directly by the user" />
            <definition value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)." />
            <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly &#39;directly chosen&#39; implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely." />
            <requirements value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Coding.userSelected" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="boolean" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="Sometimes implied by being first" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CD.codingRationale" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;     fhir:target dt:CDCoding.codingRationale\#O   ]" />
            </mapping>
        </element>
        <element id="Observation.code.text">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.code.text" />
            <short value="Plain text representation of the concept" />
            <definition value="A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user." />
            <comment value="Very often the text is the same as a displayName of one of the codings." />
            <requirements value="The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="CodeableConcept.text" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="C*E.9. But note many systems use C*E.2 for this" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data" />
            </mapping>
            <mapping>
                <identity value="orim" />
                <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" />
            </mapping>
        </element>
        <element id="Observation.subject">
            <path value="Observation.subject" />
            <short value="Who and/or what this is about" />
            <definition value="The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.  Comments: Indirect characteristics may be those of a specimen, fetus, donor,  other observer (for example a relative or EMT), or any observation made about the subject." />
            <comment value="One would expect this element to be a cardinality  of 1..1.  The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.\n\nIf the target of the observation is different than the subject, the general extension [observation-focal-subject](extension-observation-focal-subject.html).  may be used.  However, the distinction between the patient&#39;s own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code." />
            <requirements value="Observations have no value if you don&#39;t know who or what they&#39;re about." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.subject" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.subject" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="PID-3" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=SBJ]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="who.focus" />
            </mapping>
        </element>
        <element id="Observation.context">
            <path value="Observation.context" />
            <short value="Healthcare event during which this observation is made" />
            <definition value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made." />
            <comment value="This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests)." />
            <requirements value="For some observations it may be important to know the link between an observation and a particular encounter." />
            <alias value="Encounter" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.context" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare" />
            </type>
            <mapping>
                <identity value="workflow" />
                <map value="Event.context" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="PV1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="context" />
            </mapping>
        </element>
        <element id="Observation.effective[x]">
            <path value="Observation.effective[x]" />
            <short value="Often just a dateTime for Vital Signs" />
            <definition value="Often just a dateTime for Vital Signs." />
            <comment value="At least a date should be present unless this observation is a historical report." />
            <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining trends." />
            <alias value="Occurrence" />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Observation.effective[x]" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="dateTime" />
            </type>
            <type>
                <code value="Period" />
            </type>
            <constraint>
                <key value="vs-1" />
                <severity value="error" />
                <human value="Datetime must be at least to day." />
                <expression value="($this as dateTime).toString().length() &gt;= 8" />
                <xpath value="f:matches(effectiveDateTime,/\d{4}-[01]\d-[0-3]\dT[0-2]\d:[0-5]\d([+-][0-2]\d:[0-5]\d|Z)/)" />
            </constraint>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.occurrence[x]" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="effectiveTime" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="when.done" />
            </mapping>
        </element>
        <element id="Observation.issued">
            <path value="Observation.issued" />
            <short value="Date/Time this was made available" />
            <definition value="The date and time this observation was made available to providers, typically after the results have been reviewed and verified." />
            <comment value="Updated when the result is updated." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.issued" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="instant" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=AUT].time" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="when.recorded" />
            </mapping>
        </element>
        <element id="Observation.performer">
            <path value="Observation.performer" />
            <short value="Who is responsible for the observation" />
            <definition value="Who was responsible for asserting the observed value as &quot;true&quot;." />
            <requirements value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.performer" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
            </type>
            <isSummary value="true" />
            <mapping>
                <identity value="workflow" />
                <map value="Event.performer" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX.15 / (Practitioner)  OBX-16,  PRT-5:PRT-4=&#39;RO&#39; /  (Device)  OBX-18 , PRT-10:PRT-4=&#39;EQUIP&#39; / (Organization)  OBX-23,  PRT-8:PRT-4=&#39;PO&#39;" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=PRF]" />
            </mapping>
            <mapping>
                <identity value="w5" />
                <map value="who.actor" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity">
            <path value="Observation.valueQuantity" />
            <short value="Vital Sign Value recorded with UCUM" />
            <definition value="Vital Sign Value recorded with UCUM." />
            <comment value="Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is &quot;&#39;value&#39; + the type name&quot; with a capital on the first letter of the type).\n\n\nIf the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text.  A value set is bound to the ValueCodeableConcept element.    For further discussion and examples see the  [notes section](observation.html#notes) below." />
            <requirements value="9. SHALL contain exactly one [1..1] value with @xsi:type=&quot;PQ&quot; (CONF:7305)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.value[x]" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Quantity" />
            </type>
            <condition value="obs-7" />
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="VitalSignsUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for recording Vital Signs" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-vitals-common" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)" />
            </mapping>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 441742003 |Evaluation finding|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX.2, OBX.5, OBX.6" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363714003 |Interprets|" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.id">
            <path value="Observation.valueQuantity.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.extension">
            <path value="Observation.valueQuantity.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <description value="Extensions are always sliced by (at least) url" />
                <rules value="open" />
            </slicing>
            <short value="Additional Content defined by implementations" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.value">
            <path value="Observation.valueQuantity.value" />
            <short value="Numerical value (with implicit precision)" />
            <definition value="The value of the measured amount. The value includes an implicit precision in the presentation of the value." />
            <comment value="The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books)." />
            <requirements value="Precision is handled implicitly in almost all cases of measurement." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.value" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="decimal" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="SN.2  / CQ - N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.comparator">
            <path value="Observation.valueQuantity.comparator" />
            <short value="&lt; | &lt;= | &gt;= | &gt; - how to understand the value" />
            <definition value="How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is &quot;&lt;&quot; , then the real value is &lt; stated value." />
            <comment value="This is labeled as &quot;Is Modifier&quot; because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value." />
            <requirements value="Need a framework for handling measures where the value is &lt;5ug/L or &gt;400mg/L due to the limitations of measuring methodology." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Quantity.comparator" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <meaningWhenMissing value="If there is no comparator, then there is no modification of the value" />
            <isModifier value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="QuantityComparator" />
                </extension>
                <strength value="required" />
                <description value="How the Quantity should be understood and represented." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/quantity-comparator" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="SN.1  / CQ.1" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="IVL properties" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.unit">
            <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
                <valueBoolean value="true" />
            </extension>
            <path value="Observation.valueQuantity.unit" />
            <short value="Unit representation" />
            <definition value="A human-readable form of the unit." />
            <requirements value="There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.unit" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.unit" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.system">
            <path value="Observation.valueQuantity.system" />
            <short value="System that defines coded unit form" />
            <definition value="The identification of the system that provides the coded form of the unit." />
            <requirements value="Need to know the system that defines the coded form of the unit." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.system" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="uri" />
            </type>
            <fixedUri value="http://unitsofmeasure.org" />
            <condition value="qty-3" />
            <mustSupport value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="CO.codeSystem, PQ.translation.codeSystem" />
            </mapping>
        </element>
        <element id="Observation.valueQuantity.code">
            <path value="Observation.valueQuantity.code" />
            <short value="Coded responses from the common UCUM units for vital signs value set." />
            <definition value="Coded responses from the common UCUM units for vital signs value set." />
            <comment value="The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency.  The context of use may additionally require a code from a particular system." />
            <requirements value="Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest." />
            <min value="1" />
            <max value="1" />
            <base>
                <path value="Quantity.code" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="code" />
            </type>
            <mustSupport value="true" />
            <isSummary value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="BodyLengthUnits" />
                </extension>
                <strength value="required" />
                <description value="Common UCUM units for Body Length measures such as Body Height and Head Circumference" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/ucum-bodylength" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="(see OBX.6 etc.) / CQ.2" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="PQ.code, MO.currency, PQ.translation.code" />
            </mapping>
        </element>
        <element id="Observation.dataAbsentReason">
            <path value="Observation.dataAbsentReason" />
            <short value="Why the result is missing" />
            <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing." />
            <comment value="Null or exceptional values can be represented two ways in FHIR Observations.  One way is to simply include them in the value set and represent the exceptions in the value.  For example, measurement values for a serology test could be  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values.  For example, the dataAbsentReason code &quot;error&quot; could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when &gt; 0.  Because of these options, use-case agreements are required to interpret general observations for null or exceptional values." />
            <requirements value="For many results it is necessary to handle exceptional values in measurements." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.dataAbsentReason" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <condition value="obs-6" />
            <mustSupport value="true" />
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="DAR" />
                </extension>
                <strength value="extensible" />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="workflow" />
                <map value="Event.notDone, Event.notDoneReason  (maps to valeu[x] or dataAbsentReason)" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="N/A" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="value.nullFlavor" />
            </mapping>
        </element>
        <element id="Observation.interpretation">
            <path value="Observation.interpretation" />
            <short value="High, low, normal, etc." />
            <definition value="The assessment made based on the result of the observation.  Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag." />
            <requirements value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result." />
            <alias value="Abnormal Flag" />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.interpretation" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationInterpretation" />
                </extension>
                <strength value="extensible" />
                <description value="Codes identifying interpretations of observations." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-interpretation" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 260245000 |Findings values|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-8" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="interpretationCode" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="363713009 |Has interpretation|" />
            </mapping>
        </element>
        <element id="Observation.comment">
            <path value="Observation.comment" />
            <short value="Comments about result" />
            <definition value="May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result." />
            <requirements value="Need to be able to provide free text additional information." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.comment" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="workflow" />
                <map value="Event.note" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="subjectOf.observationEvent[code=&quot;annotation&quot;].value" />
            </mapping>
        </element>
        <element id="Observation.bodySite">
            <path value="Observation.bodySite" />
            <short value="Observed body part" />
            <definition value="Indicates the site on the subject&#39;s body where the observation was made (i.e. the target site)." />
            <comment value="Only used if not implicit in code found in Observation.code.  In many systems, this may be represented as a related observation instead of an inline component.   If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ body-site-instance](extension-body-site-instance.html)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.bodySite" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="BodySite" />
                </extension>
                <strength value="example" />
                <description value="Codes describing anatomical locations. May include laterality." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/body-site" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 123037004 |Body structure|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-20" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="targetSiteCode" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="718497002 |Inherent location|" />
            </mapping>
        </element>
        <element id="Observation.method">
            <path value="Observation.method" />
            <short value="How it was done" />
            <definition value="Indicates the mechanism used to perform the observation." />
            <comment value="Only used if not implicit in code for Observation.code." />
            <requirements value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.method" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="CodeableConcept" />
            </type>
            <binding>
                <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
                    <valueString value="ObservationMethod" />
                </extension>
                <strength value="example" />
                <description value="Methods for simple observations." />
                <valueSetReference>
                    <reference value="http://hl7.org/fhir/ValueSet/observation-methods" />
                </valueSetReference>
            </binding>
            <mapping>
                <identity value="v2" />
                <map value="OBX-17" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="methodCode" />
            </mapping>
        </element>
        <element id="Observation.specimen">
            <path value="Observation.specimen" />
            <short value="Specimen used for this observation" />
            <definition value="The specimen that was used when this observation was made." />
            <comment value="Should only be used if not implicit in code found in `Observation.code`.  Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report)." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.specimen" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" />
            </type>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 123038009 |Specimen|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="SPM segment" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=SPC].specimen" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="704319004 |Inherent in|" />
            </mapping>
        </element>
        <element id="Observation.device">
            <path value="Observation.device" />
            <short value="(Measurement) Device" />
            <definition value="The device used to generate the observation data." />
            <comment value="An extension should be used if further typing of the device is needed.  Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Observation.device" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
            </type>
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric" />
            </type>
            <mapping>
                <identity value="sct-concept" />
                <map value="&lt; 49062001 |Device|" />
            </mapping>
            <mapping>
                <identity value="v2" />
                <map value="OBX-17 / PRT -10" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="participation[typeCode=DEV]" />
            </mapping>
            <mapping>
                <identity value="sct-attr" />
                <map value="424226004 |Using device|" />
            </mapping>
        </element>
        <element id="Observation.referenceRange">
            <path value="Observation.referenceRange" />
            <short value="Provides guide for interpretation" />
            <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range." />
            <comment value="Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient&#39;s age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties." />
            <requirements value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts." />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Observation.referenceRange" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="BackboneElement" />
            </type>
            <constraint>
                <key value="ele-1" />
                <severity value="error" />
                <human value="All FHIR elements must have a @value or children" />
                <expression value="children().count() &gt; id.count()" />
                <xpath value="@value|f:*|h:div" />
                <source value="Element" />
            </constraint>
            <constraint>
                <key value="obs-3" />
                <severity value="error" />
                <human value="Must have at least a low or a high or text" />
                <expression value="low.exists() or high.exists() or text.exists()" />
                <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))" />
            </constraint>
            <mapping>
                <identity value="v2" />
                <map value="OBX.7" />
            </mapping>
            <mapping>
                <identity value="rim" />
                <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.id">
            <path value="Observation.referenceRange.id" />
            <representation value="xmlAttr" />
            <short value="xml:id (or equivalent in JSON)" />
            <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
            <min value="0" />
            <max value="1" />
            <base>
                <path value="Element.id" />
                <min value="0" />
                <max value="1" />
            </base>
            <type>
                <code value="string" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.extension">
            <path value="Observation.referenceRange.extension" />
            <short value="Additional Content defined by implementations" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="Element.extension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <mapping>
                <identity value="rim" />
                <map value="n/a" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.modifierExtension">
            <path value="Observation.referenceRange.modifierExtension" />
            <short value="Extensions that cannot be ignored" />
            <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions." />
            <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
            <alias value="extensions" />
            <alias value="user content" />
            <alias value="modifiers" />
            <min value="0" />
            <max value="*" />
            <base>
                <path value="BackboneElement.modifierExtension" />
                <min value="0" />
                <max value="*" />
            </base>
            <type>
                <code value="Extension" />
            </type>
            <isModifier value="true" />
            <isSummary value="true" />
            <mapping>
                <identity value="rim" />
                <map value="N/A" />
            </mapping>
        </element>
        <element id="Observation.referenceRange.low">
            <path value="Observation.referenceRange.low" />
            <short value="Low Range, if relevant" />
            <definition value="