<StructureDefinition xmlns="http://hl7.org/fhir">
  <url value="https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_Vaccination_Observation_Immunization_Status" />
  <version value="1.1.0" />
  <name value="KBV_PR_MIO_Vaccination_Observation_Immunization_Status" />
  <status value="active" />
  <publisher value="Kassenärztliche Bundesvereinigung (KBV)" />
  <copyright value="Im folgenden Profil können Codes aus den Codesystemen Snomed, Loinc oder Ucum enthalten sein, die dem folgenden Urheberrecht unterliegen: This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of SNOMED International. All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. SNOMED and SNOMED CT are registered trademarks of SNOMED International. Implementers of these artefacts must have the appropriate SNOMED CT Affiliate license. This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. This product includes all or a portion of the UCUM table, UCUM codes, and UCUM definitions or is derived from it, subject to a license from Regenstrief Institute, Inc. and The UCUM Organization. Your use of the UCUM table, UCUM codes, UCUM definitions also is subject to this license, a copy of which is available at ​http://unitsofmeasure.org. The current complete UCUM table, UCUM Specification are available for download at ​http://unitsofmeasure.org. The UCUM table and UCUM codes are copyright © 1995-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. THE UCUM TABLE (IN ALL FORMATS), UCUM DEFINITIONS, AND SPECIFICATION ARE PROVIDED &quot;AS IS.&quot; ANY EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE." />
  <fhirVersion value="4.0.1" />
  <kind value="resource" />
  <abstract value="false" />
  <type value="Observation" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" />
  <derivation value="constraint" />
  <differential>
    <element id="Observation">
      <path value="Observation" />
      <short value="Titeruntersuchung" />
      <definition value="In diesem Profil können Ergebnisse von Titer-Untersuchungen/Antikörper-Bestimmungen von impfpräventablen Erkrankungen dokumentiert werden, vor allem zur Kontrolle des Impferfolgs. Dafür wird dokumentiert, welche Titer-Bestimmung durchgeführt wurde, ob überhaupt eine Nachweisbarkeit gegeben ist und ob sich aus dem bestimmten Wert eine Immunität ableiten lässt." />
      <comment value="In der Regel werden für die meisten Impfungen bzw. impfpräventablen Erkrankungen keine Titerbestimmungen empfohlen - wenn diese jedoch angezeigt sind und durchgeführt werden, kann hier dokumentiert werden, welcher Titer bestimmt wurde und ob die Immunität anzunehmen ist." />
      <constraint>
        <key value="issued" />
        <severity value="error" />
        <human value="Das Untersuchungsdatum muss mindestens JJJJ-MM Stellen haben" />
        <expression value="issued.toString().length()&gt;=7" />
        <source value="https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_Vaccination_Observation_Immunization_Status" />
      </constraint>
      <constraint>
        <key value="Code" />
        <severity value="error" />
        <human value="Wenn der Code 26268376005 oder 268375009 oder 440662009 oder 440661002 ausgewählt wurde, dann kann die Immunität angegeben werden, ansonsten muss die Immunität angegeben werden." />
        <expression value="code.coding.where(system='http://snomed.info/sct' and (code!='268376005' and code!='268375009' and code!='440662009' and code!='440661002')).exists() implies interpretation.exists()" />
        <source value="https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_Vaccination_Observation_Immunization_Status" />
      </constraint>
    </element>
    <element id="Observation.meta">
      <path value="Observation.meta" />
      <min value="1" />
    </element>
    <element id="Observation.meta.versionId">
      <path value="Observation.meta.versionId" />
      <max value="0" />
    </element>
    <element id="Observation.meta.lastUpdated">
      <path value="Observation.meta.lastUpdated" />
      <max value="0" />
    </element>
    <element id="Observation.meta.source">
      <path value="Observation.meta.source" />
      <max value="0" />
    </element>
    <element id="Observation.meta.profile">
      <path value="Observation.meta.profile" />
      <min value="1" />
      <max value="1" />
      <fixedCanonical value="https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_Vaccination_Observation_Immunization_Status|1.1.0" />
    </element>
    <element id="Observation.meta.security">
      <path value="Observation.meta.security" />
      <max value="0" />
    </element>
    <element id="Observation.meta.tag">
      <path value="Observation.meta.tag" />
      <max value="0" />
    </element>
    <element id="Observation.implicitRules">
      <path value="Observation.implicitRules" />
      <max value="0" />
    </element>
    <element id="Observation.language">
      <path value="Observation.language" />
      <max value="0" />
    </element>
    <element id="Observation.contained">
      <path value="Observation.contained" />
      <max value="0" />
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier" />
      <max value="0" />
    </element>
    <element id="Observation.basedOn">
      <path value="Observation.basedOn" />
      <max value="0" />
    </element>
    <element id="Observation.partOf">
      <path value="Observation.partOf" />
      <max value="0" />
    </element>
    <element id="Observation.status">
      <path value="Observation.status" />
      <fixedCode value="final" />
    </element>
    <element id="Observation.category">
      <path value="Observation.category" />
      <max value="0" />
    </element>
    <element id="Observation.code">
      <path value="Observation.code" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <rules value="closed" />
      </slicing>
      <min value="1" />
      <max value="2" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT">
      <path value="Observation.code.coding" />
      <sliceName value="snomedCT" />
      <min value="1" />
      <max value="1" />
      <mustSupport value="true" />
      <binding>
        <strength value="required" />
        <valueSet value="https://fhir.kbv.de/ValueSet/KBV_VS_MIO_Vaccination_Lab_ImmuneReaction_Test_Presence_Snomed_All|1.1.0" />
      </binding>
    </element>
    <element id="Observation.code.coding:snomedCT.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://snomed.info/sct" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT.version">
      <path value="Observation.code.coding.version" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT.display">
      <path value="Observation.code.coding.display" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT.display.extension">
      <path value="Observation.code.coding.display.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.code.coding:snomedCT.display.extension:anzeigenameCodeSnomed">
      <path value="Observation.code.coding.display.extension" />
      <sliceName value="anzeigenameCodeSnomed" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="https://fhir.kbv.de/StructureDefinition/KBV_EX_Base_Terminology_German|1.1.1" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:snomedCT.display.extension:anzeigenameCodeSnomed.extension">
      <path value="Observation.code.coding.display.extension.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.code.coding:snomedCT.display.extension:anzeigenameCodeSnomed.extension:content">
      <path value="Observation.code.coding.display.extension.extension" />
      <sliceName value="content" />
    </element>
    <element id="Observation.code.coding:snomedCT.display.extension:anzeigenameCodeSnomed.extension:content.value[x]:valueString">
      <path value="Observation.code.coding.display.extension.extension.value[x]" />
      <sliceName value="valueString" />
      <short value="Anzeigename" />
      <definition value="In diesem Attribut sollen die entsprechende deutsche Bezeichnung des Loinc oder Snomed-Codes aus der Conceptmap eingetragen werden, also in diesem Fall den Displaynamen des Targetsystems aus https://fhir.kbv.de/ConceptMap/KBV_CM_MIO_Vaccination_Lab_ImmuneReaction_Test_Presence_German" />
    </element>
    <element id="Observation.code.coding:loinc">
      <path value="Observation.code.coding" />
      <sliceName value="loinc" />
      <max value="1" />
      <mustSupport value="true" />
      <binding>
        <strength value="required" />
        <valueSet value="https://fhir.kbv.de/ValueSet/KBV_VS_MIO_Vaccination_Lab_ImmuneReaction_Test_Presence|1.1.0" />
      </binding>
    </element>
    <element id="Observation.code.coding:loinc.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://loinc.org" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:loinc.version">
      <path value="Observation.code.coding.version" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:loinc.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:loinc.display">
      <path value="Observation.code.coding.display" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.code.coding:loinc.display.extension">
      <path value="Observation.code.coding.display.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.code.coding:loinc.display.extension:anzeigenameCodeLoinc">
      <path value="Observation.code.coding.display.extension" />
      <sliceName value="anzeigenameCodeLoinc" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="https://fhir.kbv.de/StructureDefinition/KBV_EX_Base_Terminology_German|1.1.1" />
      </type>
    </element>
    <element id="Observation.code.coding:loinc.display.extension:anzeigenameCodeLoinc.extension">
      <path value="Observation.code.coding.display.extension.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.code.coding:loinc.display.extension:anzeigenameCodeLoinc.extension:content">
      <path value="Observation.code.coding.display.extension.extension" />
      <sliceName value="content" />
    </element>
    <element id="Observation.code.coding:loinc.display.extension:anzeigenameCodeLoinc.extension:content.value[x]:valueString">
      <path value="Observation.code.coding.display.extension.extension.value[x]" />
      <sliceName value="valueString" />
      <short value="Anzeigename" />
      <definition value="In diesem Attribut sollen die entsprechende deutsche Bezeichnung des Loinc oder Snomed-Codes aus der Conceptmap eingetragen werden, also in diesem Fall den Displaynamen des Targetsystems aus https://fhir.kbv.de/ConceptMap/KBV_CM_MIO_Vaccination_Lab_ImmuneReaction_Test_Presence_German" />
    </element>
    <element id="Observation.code.text">
      <path value="Observation.code.text" />
      <max value="0" />
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject" />
      <min value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="https://fhir.kbv.de/StructureDefinition/KBV_PR_MIO_Vaccination_Patient|1.1.0" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Observation.subject.reference">
      <path value="Observation.subject.reference" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.subject.type">
      <path value="Observation.subject.type" />
      <max value="0" />
    </element>
    <element id="Observation.subject.identifier">
      <path value="Observation.subject.identifier" />
      <max value="0" />
    </element>
    <element id="Observation.subject.display">
      <path value="Observation.subject.display" />
      <max value="0" />
    </element>
    <element id="Observation.focus">
      <path value="Observation.focus" />
      <max value="0" />
    </element>
    <element id="Observation.encounter">
      <path value="Observation.encounter" />
      <max value="0" />
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]" />
      <max value="0" />
    </element>
    <element id="Observation.issued">
      <path value="Observation.issued" />
      <short value="Datum der Untersuchung" />
      <definition value="Dieses Element beschreibt das Datum, wann die Laboruntersuchung des Titers durchgeführt wurde." />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer" />
      <max value="0" />
    </element>
    <element id="Observation.value[x]">
      <path value="Observation.value[x]" />
      <max value="0" />
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.interpretation">
      <path value="Observation.interpretation" />
      <short value="Nachweisbarkeit" />
      <definition value="Die Nachweisbarkeit beschreibt das Erreichen der Nachweisgrenze und damit das Ergebnis des Tests. Das Ergebnis ist im Sinne von Positiv/Negativ anzugeben, dazu ist ein Code der LOINC Answer-List zu verwenden. Das Ergebnis erlaubt noch keine Aussage über die Immunität." />
      <max value="1" />
      <mustSupport value="true" />
      <binding>
        <strength value="required" />
        <valueSet value="https://fhir.kbv.de/ValueSet/KBV_VS_MIO_Vaccination_Lab_Titer_Immunity|1.1.0" />
      </binding>
    </element>
    <element id="Observation.interpretation.coding">
      <path value="Observation.interpretation.coding" />
      <min value="1" />
      <max value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.interpretation.coding.system">
      <path value="Observation.interpretation.coding.system" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.interpretation.coding.version">
      <path value="Observation.interpretation.coding.version" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.interpretation.coding.code">
      <path value="Observation.interpretation.coding.code" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.interpretation.coding.display">
      <path value="Observation.interpretation.coding.display" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.interpretation.coding.display.extension">
      <path value="Observation.interpretation.coding.display.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.interpretation.coding.display.extension:anzeigenameCodeSnomed">
      <path value="Observation.interpretation.coding.display.extension" />
      <sliceName value="anzeigenameCodeSnomed" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="https://fhir.kbv.de/StructureDefinition/KBV_EX_Base_Terminology_German|1.1.1" />
      </type>
    </element>
    <element id="Observation.interpretation.coding.display.extension:anzeigenameCodeSnomed.extension">
      <path value="Observation.interpretation.coding.display.extension.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.interpretation.coding.display.extension:anzeigenameCodeSnomed.extension:content">
      <path value="Observation.interpretation.coding.display.extension.extension" />
      <sliceName value="content" />
    </element>
    <element id="Observation.interpretation.coding.display.extension:anzeigenameCodeSnomed.extension:content.value[x]:valueString">
      <path value="Observation.interpretation.coding.display.extension.extension.value[x]" />
      <sliceName value="valueString" />
      <short value="Anzeige" />
      <definition value="In diesem Attribut sollen die entsprechende deutsche Bezeichnung des Snomed-Codes aus der Conceptmap eingetragen werden, also in diesem Fall den Displaynamen des Targetsystems aus https://fhir.kbv.de/ConceptMap/KBV_CM_MIO_Vaccination_Lab_Titer_Immunity_German" />
    </element>
    <element id="Observation.interpretation.coding.userSelected">
      <path value="Observation.interpretation.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.interpretation.text">
      <path value="Observation.interpretation.text" />
      <max value="0" />
    </element>
    <element id="Observation.note">
      <path value="Observation.note" />
      <short value="Ergänzende Angaben zur Titerbestimmung" />
      <definition value="Ergänzende Angaben zur Titerbestimmung" />
      <max value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Observation.note.author[x]">
      <path value="Observation.note.author[x]" />
      <max value="0" />
    </element>
    <element id="Observation.note.time">
      <path value="Observation.note.time" />
      <max value="0" />
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite" />
      <max value="0" />
    </element>
    <element id="Observation.method">
      <path value="Observation.method" />
      <max value="0" />
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen" />
      <max value="0" />
    </element>
    <element id="Observation.device">
      <path value="Observation.device" />
      <max value="0" />
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange" />
      <max value="0" />
    </element>
    <element id="Observation.hasMember">
      <path value="Observation.hasMember" />
      <max value="0" />
    </element>
    <element id="Observation.derivedFrom">
      <path value="Observation.derivedFrom" />
      <max value="0" />
    </element>
    <element id="Observation.component">
      <path value="Observation.component" />
      <max value="0" />
    </element>
  </differential>
</StructureDefinition>