<StructureDefinition xmlns="http://hl7.org/fhir">
  <meta>
    <lastUpdated value="2017-08-04T05:45:05.989-04:00" />
    <profile value="PhdRtsaObservation" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="oo" />
  </extension>
  <url value="http://pchalliance.org/phdfhir/StructureDefinition/PhdRtsaObservation" />
  <name value="PhdRtsaObservation" />
  <status value="draft" />
  <date value="2017-06-02T14:29:52.39367-04:00" />
  <description value="Base StructureDefinition for Observation Resource representing measurement data coming from a medical device where the measurement is a waveform." />
  <fhirVersion value="3.0.0" />
  <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" />
      <definition value="The PhdRtsaObservation reports PHD measurements that contain a Simple-Sa-Observed-Value attribute." />
      <comment value="Used for RTSA (waveform) observations from Personal Health Devices" />
    </element>
    <element id="Observation.meta.profile">
      <path value="Observation.meta.profile" />
      <min value="1" />
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="value" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.identifier:conditionalCreateIdentifier">
      <path value="Observation.identifier" />
      <sliceName value="conditionalCreateIdentifier" />
      <short value="Unique identifier of this measurement for a given patient and device" />
      <definition value="An identifier created from a combination of the measurement parameters like sensor time stamp, type code, value, units code, patient and device identifiers, and selected elements of any component elements." />
      <comment value="This value is used in the conditional create to prevent data duplication. PHDs will often re-send already sent data for a variety of reasons. This element is required unless the metric measurement contains no time stamp or is a measurement containing a time stamp that is real time. By real time the time stamp reported by the PHD must be later than the current time reported by the PHD before any measurements are received. Temporarily stored data from IEEE 11073 20601 devices, which are required to delete the data after sending, can also be considered real time. Temporarily stored data from Bluetooth Low Energy Health devices may be resent so these cannot be considered as real time." />
      <requirements value="Allows observations to be distinguished in a selective enough manner to prevent resource duplication." />
      <max value="1" />
    </element>
    <element id="Observation.identifier:conditionalCreateIdentifier.value">
      <path value="Observation.identifier.value" />
      <min value="1" />
    </element>
    <element id="Observation.identifier:additionalIdentifiers">
      <path value="Observation.identifier" />
      <sliceName value="additionalIdentifiers" />
      <comment value="Use of additional identifiers is allowed by this profile" />
    </element>
    <element id="Observation.status">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final" />
      </extension>
      <path value="Observation.status" />
      <definition value="The status of the result value. Either 'final' or 'preliminary'" />
      <comment value="The value shall be set to 'final' unless a Measurement-Status attribute or Nu-Observed-Value attribute status field indicates that the measurement is preliminary. In that case this field shall be set to 'preliminary'" />
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.code.coding:11073Type">
      <path value="Observation.code.coding" />
      <sliceName value="11073Type" />
      <short value="The 11073-10101 code for the measurement" />
      <comment value="For non-compound 11073-20601 metric numeric measurements, this code is obtained from one or more of the Type, Metric-Id, Nu-Observed-Value, and Metric-Id-Partition attributes. The algorithm to get the 16-bit partition and 16-bit term code is as follows:&#xD;&#xA;&#xD;&#xA;1. The partition and term code are obtained from the Type attribute.&#xD;&#xA;2. If there is a Metric-Id attribute the term code comes from this attribute.&#xD;&#xA;3. If there is a Nu-Observed-Value attribute the term code comes from this attribute.&#xD;&#xA;4. If the term code is NOT from the Type attribute, and there is a Metric-Id-Partition attribute, the partition comes from this attribute.&#xD;&#xA;5. The 32-bit 11073-10101 code value is given by partition * 2 **16 + term code.&#xD;&#xA;&#xD;&#xA;It is this value that is placed in the code.coding.code element for this 11073Type slice" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.code.coding:11073Type.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.code.coding:11073Type.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.code.coding:LoincCoding">
      <path value="Observation.code.coding" />
      <sliceName value="LoincCoding" />
      <max value="1" />
    </element>
    <element id="Observation.code.coding:LoincCoding.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://loinc.org" />
    </element>
    <element id="Observation.code.coding:LoincCoding.code">
      <path value="Observation.code.coding.code" />
      <comment value="Required if the measurement is a vital sign" />
      <min value="1" />
    </element>
    <element id="Observation.code.coding:alternativeCoding">
      <path value="Observation.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="A reference to a code describing the meaning of the primary 11073 code in an alternative terminology system." />
    </element>
    <element id="Observation.code.coding:alternativeCoding.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.code.coding:alternativeCoding.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject" />
      <min value="1" />
    </element>
    <element id="Observation.subject.reference">
      <path value="Observation.subject.reference" />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]" />
      <slicing>
        <discriminator>
          <type value="exists" />
          <path value="start" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <definition value="The time or time-period the observed value is asserted as being true. It is a time period if a Measurement-Duration attribute is part of the metric measurement sent by the PHD. Otherwise it is the time stamp sent by the PHD or the time of reception by the PHG if the PHD sent no time stamp." />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]:dateTimeEffective">
      <path value="Observation.effective[x]" />
      <sliceName value="dateTimeEffective" />
      <comment value="A date and time shall always be present." />
      <type>
        <code value="dateTime" />
      </type>
    </element>
    <element id="Observation.effective[x]:periodEffective">
      <path value="Observation.effective[x]" />
      <sliceName value="periodEffective" />
      <definition value="The time period when there is a Measurement-Duration attribute. The difference between the end and start fields is the value of the Measurement-Duration." />
      <type>
        <code value="Period" />
      </type>
    </element>
    <element id="Observation.effective[x]:periodEffective.start">
      <path value="Observation.effective[x].start" />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]:periodEffective.end">
      <path value="Observation.effective[x].end" />
      <min value="1" />
    </element>
    <element id="Observation.value[x]:valueSampledData">
      <path value="Observation.valueSampledData" />
      <sliceName value="valueSampledData" />
      <definition value="The information determined as a result of making the observation, when the observation consists of a periodic sample of numeric measurements." />
      <comment value="The RTSA metric is typically used for reporting waveform type data such as an ECG trace, spirometer exhalation rates, pulse oximetry pleth waves, etc., though it can be used to report any set of numric measurements that are periodic. The periodicity is important as the time stamps of each individual entry is known from the start time and the period. Since the amount of data to be transmitted can be large, the data is scaled in such a way to minimize the number of bits taken up by each entry (though the minimization is restricted to 8, 16, or 32 bits). This scaling information is sent along with the start time and period in order for the receiver to recover the original data and to obtain the time stamp of each data point. In theory, this data could be sent using countless phdNumericObservation type resources at a great cost in bandwidth!" />
      <type>
        <code value="SampledData" />
      </type>
    </element>
    <element id="Observation.value[x]:valueSampledData.origin">
      <path value="Observation.valueSampledData.origin" />
      <sliceName value="SimpleQuantity" />
      <short value="Scaling intecept value and units" />
      <definition value="The 'origin' data type contains the 'y-intercept' for the equation that relates the scaled data to the actual data. If valueSampledData.data[i] is the array of sampled scaled data, the actual data is obtained by:&#xD;&#xA;x[i] =valueSampledData.data[i] * valueSampledData.factor + valueSampledData.origin.value" />
      <comment value="The data sent in the Sa-Simple-Observation-Value array is also scaled. Thus with the proper setting of the valueSampledData.origin.value and valueSampledData.factor, the data from the IEEE device can be placed into the data[i] array without modification." />
    </element>
    <element id="Observation.value[x]:valueSampledData.origin.value">
      <path value="Observation.valueSampledData.origin.value" />
      <short value="Intercept value (with implicit precision)" />
      <definition value="The intercept value with the indicated precision of the data as determined by the device." />
      <min value="1" />
    </element>
    <element id="Observation.value[x]:valueSampledData.origin.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.valueSampledData.origin.unit" />
      <definition value="A human-readable form of the unit. Should be the UCUM string. If the UCUM string has {} in it, it is preferred to place contents in it so it is easily human readable." />
    </element>
    <element id="Observation.value[x]:valueSampledData.origin.system">
      <path value="Observation.valueSampledData.origin.system" />
      <short value="The 11073 coding system" />
      <definition value="The identification of the MDC coding system that provides the coded form of the unit." />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.value[x]:valueSampledData.origin.code">
      <path value="Observation.valueSampledData.origin.code" />
      <definition value="The unit code." />
      <comment value="The 32-bit code obtained from the Unit Code attribute noting that the partition is always 4." />
      <min value="1" />
    </element>
    <element id="Observation.value[x]:valueSampledData.factor">
      <path value="Observation.valueSampledData.factor" />
      <min value="1" />
    </element>
    <element id="Observation.value[x]:valueSampledData.dimensions">
      <path value="Observation.valueSampledData.dimensions" />
      <short value="Number of rtsa sample points at each time point" />
      <definition value="The number of rtsa sample points at each time point. This value gives the number of data points in the valueSampledData.data[] array." />
      <comment value="This value is obtained from the Sa-Specification.array-size field of the Sa-Specification attribute." />
    </element>
    <element id="Observation.value[x]:valueSampledData.data">
      <path value="Observation.valueSampledData.data" />
      <definition value="A series of data points which are decimal values separated by a single space (character u20). The special values &quot;E&quot; (error), &quot;L&quot; (below detection limit) and &quot;U&quot; (above detection limit) are not used. The device does not provide such individual values." />
      <comment value="One is strongly encouraged to use the scaling from the 11073 device as it is likely the scaling was chosen to optimize transmission. If&#xD;&#xA;A = Scale-and-Range-SpecificationX.lower-absolute-value as an Mder FLOAT&#xD;&#xA;B = Scale-and-Range-SpecificationX.upper-absolute-value as an Mder FLOAT&#xD;&#xA;I = Scale-and-Range-SpecificationX.lower-scaled-value as a X-bit integer&#xD;&#xA;J = Scale-and-Range-SpecificationX.upper-scaled-value as a X-bit integer&#xD;&#xA;&#xD;&#xA;valueSampledData.factor is given by (A-B)/(I-J)&#xD;&#xA;and&#xD;&#xA;valueSampledData.origin.value = A – (A-B)*I/(I-J)&#xD;&#xA;and &#xD;&#xA;valueSampledData.data[i] = Sa-Simple-Observed-Value.values[i]" />
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason" />
      <definition value="Provides a reason why the expected value in the element Observation.valueQuantity is missing. This could be a NaN (Not a Number), PINF (Positive infinity), NINF (Negative infinity)  or an error condition indicated by the Measurement-Status attribute." />
      <comment value="The current values in the http://hl7.org/fhir/data-absent-reason system do not provide the same detailed set of options reported in the numeric attributes. For example, the PINF, NINF, and not at this resolution special values have no matching codes. In those cases one uses the generic 'error' code." />
    </element>
    <element id="Observation.dataAbsentReason.coding.system">
      <path value="Observation.dataAbsentReason.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.dataAbsentReason.coding.code">
      <path value="Observation.dataAbsentReason.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.device">
      <path value="Observation.device" />
      <comment value="This field will reference the DeviceComponent when the updated fixes are in place. In the meantime it will reference the DeviceMetric" />
      <min value="1" />
    </element>
    <element id="Observation.device.reference">
      <path value="Observation.device.reference" />
      <short value="Reference to the device responsible for the measurement" />
      <definition value="Reference to the device-related resources that describe the sensor device taking the measurement and the gateway that handled it." />
      <comment value="This reference points to the DeviceComponent resource chain containing information about the sensor device  that took the measurement and gateway (if any) that handled it." />
      <min value="1" />
    </element>
    <element id="Observation.related">
      <path value="Observation.related" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="target.reference" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.related:coincidentTimeStampRelated">
      <path value="Observation.related" />
      <sliceName value="coincidentTimeStampRelated" />
      <short value="Pointer to the Coincident Time Stamp" />
      <definition value="A reference to the Coincident Time Stamp observation. The Coincident Time Stamp indicates how the time stamps from the PHD are corrected, if at all." />
      <comment value="This reference shall be present if the PHD reports a time stamp. The reference shall point to the Coincident Time Stamp observation. The Coincident Time Stamp Observation provides an audit of the time stamp. Whether or not the gateway corrected the time stamp can be determined from the elements in this Observation. If the timestamps were corrected, the elements of the Observation can be used to obtain the actual time stamps reported by the PHD.&#xD;&#xA;&#xD;&#xA;There is no reference to a Coincident Time Stamp Observation when the PHD does not report a time stamp." />
      <requirements value="This Observation allows one to re-create the original time stamp generated by the PHD should it have been modified by the PHG." />
    </element>
    <element id="Observation.related:coincidentTimeStampRelated.target.reference">
      <path value="Observation.related.target.reference" />
      <min value="1" />
    </element>
    <element id="Observation.related:SourceHandleReferenceRelated">
      <path value="Observation.related" />
      <sliceName value="SourceHandleReferenceRelated" />
      <comment value="A measurement may have one or more source handle references which point to measurements that this measurement is related to in some way. When one of these attributes are present in the measurement, these values point to other measurements. In this case these measurements will be previously generated Observation resources which are then referenced here. Note that the previously received measurement must be received in the same connection as the current measurement. The application does not need to keep record of all measurements from the given device!" />
      <requirements value="Points to a measurement that this measurement is related to or dependent upon, for example a BMI which is calculated from a weight and height measurement or a heart rate taken during a running session." />
    </element>
    <element id="Observation.related:SourceHandleReferenceRelated.target.reference">
      <path value="Observation.related.target.reference" />
      <min value="1" />
    </element>
    <element id="Observation.related:additionalRelated">
      <path value="Observation.related" />
      <sliceName value="additionalRelated" />
      <comment value="Additional references are allowed but out of scope of this profile" />
    </element>
    <element id="Observation.component">
      <path value="Observation.component" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code.coding.code" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.component:supplementalTypesComponent">
      <path value="Observation.component" />
      <sliceName value="supplementalTypesComponent" />
      <definition value="For each paritition:term code pair contained in the Supplemental-Types attribute, a separate supplementalTypesComponent element is generated. The component is not generated if the attribute is absent or empty. The component shall be generated otherwise." />
      <comment value="A PHD may send a Supplemental-Types attribute as part of the measurement. This attribute consists of a set of MDC nomenclature codes as partition:term code pairs. Each pair is a code describing something additional about the measurement, such as MDC_MODALITY_SPOT in the pulse oximeter which indicates that the provided meausrement is a stable average. An MDC_MODALITY_FAST would indicate that a short averaging is used and the result reported regardless of stability." />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="68193 is the 32-bit nomenclature code indicating a 'Supplemental-Types' value" />
      <min value="1" />
      <fixedCode value="68193" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="It is recommended to display at least the reference identifier for the Supplemental-Types which is MDC_ATTR_SUPPLEMENTAL_TYPES" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The Supplemental-Types concept expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept">
      <path value="Observation.component.valueCodeableConcept" />
      <sliceName value="valueCodeableConcept" />
      <definition value="The information determined as a result of making the observation, if the information is a code." />
      <min value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="11073Value" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="For the given Supplemental-Types entry the code here is given by: partition * 2**16 + term code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The given Supplemental-Types entry value expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:relativeTimeComponent">
      <path value="Observation.component" />
      <sliceName value="relativeTimeComponent" />
      <definition value="This component shall be present if the measurement contains a Relative-Time-Stamp." />
      <comment value="Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device.&#xD;&#xA;The Relative-Time-Stamp is a 32-bit unsigned integer in units of 1/8th ms." />
      <max value="1" />
    </element>
    <element id="Observation.component:relativeTimesComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code of the Relative-Time-Stamp attribute" />
      <min value="1" />
      <fixedCode value="67985" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier should be included in the description. For a Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <definition value="The value of the relative time attribute which is in units of 1/8th milliseconds scaled to microseconds." />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <definition value="A human-readable form of the unit in this case the UCUM code for microseconds (us)" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <definition value="The unit code shall use the MDC system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <definition value="The MDC code for microseconds is 264339" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent">
      <path value="Observation.component" />
      <sliceName value="hiresRelativeTimeComponent" />
      <definition value="This component shall be present if the measurement contains Hi-Res-Relative-Time-Stamp." />
      <comment value="Hi Res Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device.&#xD;&#xA;The Hi-Res-Relative-Time-Stamp is a 64-bit unsigned interger in units of microseconds." />
      <max value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Hi-Res-Relative-Time-Stamp attribute" />
      <min value="1" />
      <fixedCode value="68073" />
    </element>
    <element id="Observation.component:hiresRelativeTime.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier should be included in the description. For a Hi-Res-Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL_HI_RES" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <definition value="The value of the hi res relative time attribute (already in microseconds)." />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <definition value="A human-readable form of the unit in this case the UCUM code for microseconds (us)" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <definition value="The unit code shall use the MDC system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <definition value="The MDC code for microseconds is 264339" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:accuracyComponent">
      <path value="Observation.component" />
      <sliceName value="accuracyComponent" />
      <definition value="This component shall be present if the accuracy attribute is present." />
      <max value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The code for the accuracy attribute is 67914" />
      <min value="1" />
      <fixedCode value="67914" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="Should include the reference identifier for the Accuracy-Attribute MDC_ATTR_NU_ACCUR_MSMT" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The accuracy expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:accuracyComponent.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <definition value="This is the value of the accuracy attribute. The value is Mder FLOAT encoded and shall be expressed to the precision indicated by the Mder FLOAT." />
      <min value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <definition value="A human-readable form of the unit. One should put the UCUM code for the units in this display string. It shall match the UCUM code in Observation.valueQuantity.unit if UCUM is used there." />
    </element>
    <element id="Observation.component:accuracyComponent.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <definition value="The unit code shall use the MDC system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:accuracyComponent.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <definition value="The units are given by the units of the measurement so this shall have the code as in Observation.valueQuantity.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:accuracyComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:unitLabelStringComponent">
      <path value="Observation.component" />
      <sliceName value="unitLabelStringComponent" />
      <definition value="This component reports the value in the Unit-Label-String attribute. Reporting the Unit-Label-String attribute value is optional." />
      <comment value="This attribute consist of a human readable string giving a further description of the measurement units" />
      <max value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Unit-Label-String attribute" />
      <min value="1" />
      <fixedCode value="133529" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier for the attribute should be included. The Unit-Label-String attribute ref id is MDC_ATTR_UNIT_LABEL_STRING" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="This element allows the expression of the unit label sting in alternative coding systems." />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.value[x]:valueString">
      <path value="Observation.component.valueString" />
      <sliceName value="valueString" />
      <min value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="Observation.component:unitLabelStringComponent.value[x]:valueString.value">
      <path value="Observation.component.valueString.value" />
      <definition value="This is the value of the unit label string attribute." />
      <min value="1" />
    </element>
    <element id="Observation.component:unitLabelStringComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:labelStringComponent">
      <path value="Observation.component" />
      <sliceName value="labelStringComponent" />
      <definition value="This component reports the value in Label-String attribute. Reporting the Label-String attribute information is optional." />
      <comment value="This attribute consists of a human readable string giving a further description of the measurement type" />
      <max value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Label-String attribute" />
      <min value="1" />
      <fixedCode value="133415" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier for the attribute should be included. The Label-String attribute ref id is MDC_ATTR_LABEL_STRING" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="These elements allow the expression of the label string in alternative coding systems." />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.value[x]:valueString">
      <path value="Observation.component.valueString" />
      <sliceName value="valueString" />
      <min value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="Observation.component:labelStringComponent.value[x]:valueString.value">
      <path value="Observation.component.valueString.value" />
      <definition value="This is the value of the label string attribute." />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:alertOpStateComponent">
      <path value="Observation.component" />
      <sliceName value="alertOpStateComponent" />
      <definition value="This component gives one of the settings reported in the Alert-Op-State attribute. This attribute is used only by the Pulse Oximeter specialization.&#xD;&#xA;The Alert-Op-State attribute is used in conjunction with the Current-Limits and Measurement-Status attributes. The Current-Limits defines upper and lower limit thresholds for a reported measurement value. When the reported measurement value goes below or above these limits, a bit is set in the Measurement-Status attribute is set if the Alert-Op-State attribute indicates that the alert is active for the given threshold. Since it is considered important that if a Current-Limits attribute is present an alert shall be sent went the thresholds are crossed, the Alert-Op-State Bits are only set when the alert is, for some reason, turned OFF for a given threshold.&#xD;&#xA;There shall be one such alertOpStateComponent entry for every bit set in the Alert-Op-State attribute. There may be an entry for the defined cleared components as well." />
      <comment value="Recall that when creating the code for this entry that the code uses the MDER-Bit setting to be reported along with the Alert-Op-State attribute's MDC code. MDER-Bit 0 is the most significant bit of the attribute value. Since the Alert-Op-State attribute is a BITS-16 value, MDER-Bit 0 would have value 0x8000 and MDER-Bit 1 would have value 0x4000. Only bits 0, 1, and 2 are defined for this attribute." />
      <requirements value="This component indicates if a given alert condition is turned off." />
    </element>
    <element id="Observation.component:alertOpStateComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <comment value="Normally alternative coding systems are allowed but in this case the value is intimately tied to the code. The code represents the feature indicated by a bit settin in the attribute value. which is either cleared (0) or set (1). Thus the value for this entry is itself a binary 'y' or 'n' code from http://hl7.org/fhir/v2/0136" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:alertOpStateComponent.code.coding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/IEEE.ASN1" />
    </element>
    <element id="Observation.component:alertOpStateComponent.code.coding.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="This code, which is an alpha-numeric string, is generated by the attribute MDC code, which is 68746 for the Alert-Op-State, followed by a dot (.) followed by the MDER-bit that was set. Given that only three bits are defined in the Pulse Ox specialization that uses this attribute, the code will be one of 68746.0, 68746.1. or 68746.2" />
      <comment value="Note that this code is an alpha-numeric string and not a decimal number. Think of it like a very-limited OID." />
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpStateComponent.value[x]">
      <path value="Observation.component.valueCodeableConcept" />
      <min value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:alertOpStateComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:alertOpStateComponent.value[x]:valueCodeableConcept.coding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <definition value="This coding system contains only two entries, 'y' (yes) and 'n' (no)" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/v2/0136" />
    </element>
    <element id="Observation.component:alertOpStateComponent.value[x]:valueCodeableConcept.coding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="If the MDER-Bit is set, the code value is 'y' otherwise it is 'n'" />
      <comment value="Recall that when the value is 'y' the alarm or alert is turned off" />
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpStateComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:currentLimitsComponent">
      <path value="Observation.component" />
      <sliceName value="currentLimitsComponent" />
      <definition value="The Current-Limits attribute gives upper and lower threshhold values for the triggering of an alert for the measured value being reported in this Observation resource. This attribute is currently used only in the Pulse Oximeter specialization. If the alerting is not turned off, a Measurement-Status attribute bit is set when either threshold is crossed. The Current-Limits attribute value shall be reported if it is present in the measurement." />
      <comment value="The value is expressed as a range. The lower and upper values of the range represent the thresholds." />
      <requirements value="Allows the downstream signaling of an alert and/or warning situation." />
      <max value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.component.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <definition value="Indicates the MDC coding system" />
      <comment value="The code is that of the Current-Limits attribute" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="Shall be the code of the Current-Limits attribute." />
      <min value="1" />
      <fixedCode value="67892" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="Should include the reference id for the Current-Limits attribute which is MDC_ATTR_LIMIT_CURR" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The Current-Limits concept expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.value[x]">
      <path value="Observation.component.valueRange" />
      <min value="1" />
      <type>
        <code value="Range" />
      </type>
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.low">
      <path value="Observation.component.valueRange.low" />
      <sliceName value="SimpleQuantity" />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.low.value">
      <path value="Observation.component.valueRange.low.value" />
      <definition value="Thsi value is given by Current-Limits.lower as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct." />
      <comment value="This gives the lower threshold. If the measurement falls below this value, the Measurement-Status attribute is sent with a bit stating the alert is present (if the alerts are not turned off for the lower limits)." />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.low.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueRange.low.unit" />
      <definition value="A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present." />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.low.system">
      <path value="Observation.component.valueRange.low.system" />
      <definition value="Indicates the MDC coding system." />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.low.value.code">
      <path value="Observation.component.valueRange.low.code" />
      <definition value="This code (which is the code for the units) shall be the same as Observation.valueQuantity.code" />
      <comment value="The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader." />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.high">
      <path value="Observation.component.valueRange.high" />
      <sliceName value="SimpleQuantity" />
      <comment value="The high limit shall be present" />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.high.value">
      <path value="Observation.component.valueRange.high.value" />
      <definition value="Thsi value is given by Current-Limits.upper as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct." />
      <comment value="This gives the upper threshold. If the measurement goes above this value, the Measurement-Status attribute is sent with a bit stating the alert is present (if the alerts are not turned off for the upper limits)." />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.high.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueRange.high.unit" />
      <definition value="A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present." />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.high.system">
      <path value="Observation.component.valueRange.high.system" />
      <definition value="Indicates the MDC coding system." />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:currentLimitsComponent:value[x].valueRange.high.code">
      <path value="Observation.component.valueRange.high.code" />
      <definition value="This code (which is the code for the units) shall be the same as Observation.valueQuantity.code" />
      <comment value="The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader." />
      <min value="1" />
    </element>
    <element id="Observation.component:currentLimitsComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent">
      <path value="Observation.component" />
      <sliceName value="alertOpTextStringComponent" />
      <definition value="This component reports the values in the Alert-Op-Text-String attribute. Reporting the this attribute information is optional." />
      <comment value="This attribute consists of human readable strings giving further information about the upper and lower limits" />
      <max value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Alert-Op-Text-String attribute" />
      <min value="1" />
      <fixedCode value="68104" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier for the attribute should be included. The Alert-Op-Text-String attribute ref id is MDC_ATTR_AL_OP_TEXT_STRING" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="These elements allow the expression of the alert op text string in alternative coding systems." />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.value[x]:valueString">
      <path value="Observation.component.valueString" />
      <sliceName value="valueString" />
      <min value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="Observation.component:alertOpTextStringComponent.value[x]:valueString.value">
      <path value="Observation.component.valueString.value" />
      <definition value="This is the value of the lower and upper text strings presented in an application specific manner." />
      <min value="1" />
    </element>
    <element id="Observation.component:alertOpTextStringComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:measurementConfidence95Component">
      <path value="Observation.component" />
      <sliceName value="measurementConfidence95Component" />
      <definition value="The Measurement-Confidence-95 attribute defines the lower and upper bounds for a range within which the manufacture is 95% confident that the actual value resides. The unit for the lower bound and upper bound is the same as the measurement." />
      <requirements value="Provides a level of confidence for the reported measurement." />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <definition value="Indicates the MDC coding system" />
      <comment value="The code is that of the Current-Limits attribute" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="Shall be the code of the Current-Limits attribute." />
      <min value="1" />
      <fixedCode value="526998" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="Should include the reference id for the Current-Limits attribute which is MDC_ATTR_MSMT_CONFIDENCE_95" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The Current-Limits concept expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.value[x]">
      <path value="Observation.component.valueRange" />
      <min value="1" />
      <type>
        <code value="Range" />
      </type>
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.low">
      <path value="Observation.component.valueRange.low" />
      <sliceName value="SimpleQuantity" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.low.value">
      <path value="Observation.component.valueRange.low.value" />
      <definition value="Thsi value is given by Measurement-Confidence-95.lower-bound as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct." />
      <comment value="This gives the lower value for the manufacturer is 95% confident that the measurement reported is that of the real value." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.low.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueRange.low.unit" />
      <definition value="A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present." />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.low.system">
      <path value="Observation.component.valueRange.low.system" />
      <definition value="Indicates the MDC coding system." />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.low.value.code">
      <path value="Observation.component.valueRange.low.code" />
      <definition value="This code (which is the code for the units) shall be the same as Observation.valueQuantity.code" />
      <comment value="The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.high">
      <path value="Observation.component.valueRange.high" />
      <sliceName value="SimpleQuantity" />
      <comment value="The high limit shall be present" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.high.value">
      <path value="Observation.component.valueRange.high.value" />
      <definition value="Thsi value is given by Measurement-Confidence-95.upper-bound as an MDER-FLOAT and shall be expressed in the precsion indcated by the MDER-FLOAT construct." />
      <comment value="This gives the upper value for the manufacturer is 95% confident that the measurement reported is that of the real value." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.high.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueRange.high.unit" />
      <definition value="A human-readable form of the unit. It is suggested that the UCUM code is used in this string with the {} filled should they be present." />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.high.system">
      <path value="Observation.component.valueRange.high.system" />
      <definition value="Indicates the MDC coding system." />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:measurementConfidence95Component:value[x].valueRange.high.code">
      <path value="Observation.component.valueRange.high.code" />
      <definition value="This code (which is the code for the units) shall be the same as Observation.valueQuantity.code" />
      <comment value="The MDC units are required to assure no ambiguity in translation. UCUM is optionally placed in the unit element if it is known by the uploader." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementConfidence95Component.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent">
      <path value="Observation.component" />
      <sliceName value="thresholdNotificationTextStringComponent" />
      <definition value="This component reports the values in the Threshold-Notification-Text-String attribute. Reporting the this attribute information is optional." />
      <comment value="This attribute consists of human readable strings giving further information threshold notification(s)" />
      <max value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Threshold-Notification-Text-String attribute" />
      <min value="1" />
      <fixedCode value="68232" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier for the attribute should be included. The Threshold-Notification-Text-String attribute ref id is MDC_ATTR_THRES_NOTIF_TEXT_STRING" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="These elements allow the expression of the Threshold-Notification-Text-String attribute in alternative coding systems." />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.value[x]:valueString">
      <path value="Observation.component.valueString" />
      <sliceName value="valueString" />
      <min value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.value[x]:valueString.value">
      <path value="Observation.component.valueString.value" />
      <definition value="This is the value of the text string." />
      <min value="1" />
    </element>
    <element id="Observation.component:thresholdNotificationTextStringComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:measurementStatusComponent">
      <path value="Observation.component" />
      <sliceName value="measurementStatusComponent" />
      <definition value="This component gives one of the settings reported in the Measurement-Status attribute that are not reported in the Observation.dataAbsentReason or Observation.status element. The settings that ARE reported in the dataAbsentReason and status elements are 'invalid', 'questionable', 'not-available', and 'early-indication'. It is optional to report any of the other settings UNLESS MDER-BITs 14 or 15 are set. It is optional to report any defined cleared setting." />
      <comment value="When MDER-BITs 14 and 15 are set, these are special uses cases by the Pulse Oximeter and Continuous Glucose specialization. MDER-BIT 14 indicates that a threshold set up in other attributes has been crossed. MDER-BIT 15 indicates that the alert mechanism has been turned off.  There will be one measurementStatusComponent entry for every setting reported." />
      <requirements value="This component indicates a Measurement-Status setting." />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <comment value="Normally alternative coding systems are allowed but in this case the value is intimately tied to the code. The code represents the feature indicated by a bit settin in the attribute value. which is either cleared (0) or set (1). Thus the value for this entry is itself a binary 'y' or 'n' code from http://hl7.org/fhir/v2/0136" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/IEEE.ASN1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="This code, which is an alpha-numeric string, is generated by the attribute MDC code, which is 133447 for the Measurement-Status, followed by a dot (.) followed by the MDER-bit that was set." />
      <comment value="Note that this code is an alpha-numeric string and not a decimal number. Think of it like a very-limited OID. MDER-BITs 14 and 15 shall be reported if set." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]">
      <path value="Observation.component.valueCodeableConcept" />
      <min value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <definition value="This coding system contains only two entries, 'y' (yes) and 'n' (no)" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/v2/0136" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="If the MDER-Bit is set, the code value is 'y' otherwise it is 'n'" />
      <comment value="Recall that when the value is 'y' the alarm or alert is turned off" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
  </differential>
</StructureDefinition>