US Core Implementation Guide
9.0.0 - STU 9 US

US Core Implementation Guide - Downloaded Version 9.0.0 See the Directory of published versions

## Resource Profile: US Core Vital Signs Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs | Version: 9.0.0
Standards status: Trial-use | Maturity Level: 5 | Computable Name: USCoreVitalSignsProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.68
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile is based on the base FHIR Vital Signs Profile and defines additional constraints on the Observation resource to represent vital signs observations. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. This US Core profiles that are derived from this profile are listed below.

### Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile-specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. The "Snapshot Table (Must Support)" tab below displays all the Mandatory and Must Support data elements for this profile and those inherited from the US Core Vital Signs Profile.

Each Observation Must Have:

1. a status
2. a category code of "vital-signs"
3. a LOINC code, if available, which tells you what is being measured
4. a patient
5. a clinically relevant time

Each Observation Must Support:

1. a performer2
2. a result value
   - if the result value is a numeric quantity, a standard UCUM unit
3. a reason if the value is absent1
4. component results

1,2 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

- The observations MAY have additional codes that translate or map to the Observation code or category codes.§ For example:
  - providing a local system-specific code
  - providing more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.

  A code system value SHOULD be supplied for each additional code.§

- The observations MAY have component observations.§ For example, to qualify the vital sign observation, 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. The FHIR core specification vital signs table provides several of these.
- 1An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using `Observation.hasMember`.§,§
  - For further guidance, see the Observation Grouping section in FHIR Specification.
  - Systems that never provide an observation without a value MAY choose not to support `Observation.dataAbsentReason`.§
- 1An `Observation.component` without a value, SHALL include a reason why the data is absent.§
  - Systems that never provide a component observation without a component value MAY choose not to support `Observation.component.dataAbsentReason`.§
- Implementers may use this profile as a base for other vital signs in addition to those in this guide.

- 2The profile elements `Observation.performer and Observation.device` communicate the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

This profile conforms to the base FHIR ver 4.0.1 vitals profile, which defines a required binding for `Quantity.code` concepts. This means validation errors occur when validating derived profiles that use other `Quantity.code` concepts such as `L/min` for `Observation.component.value(x)` in the US Core Pulse Oximetry Profile. This known issue has been corrected in the base FHIR specification since version 4.3.0 ("Release 4B").

Usages:

- Derived from this Profile: US Core Pediatric Head Occipital Frontal Circumference Percentile Profile, US Core Pediatric BMI for Age Observation Profile, US Core Pediatric Weight for Height Observation Profile, US Core Blood Pressure Profile... Show 8 more, US Core BMI Profile, US Core Body Height Profile, US Core Body Temperature Profile, US Core Body Weight Profile, US Core Head Circumference Profile, US Core Heart Rate Profile, US Core Pulse Oximetry Profile and US Core Respiratory Rate Profile
- CapabilityStatements using this Profile: US Core Client CapabilityStatement and US Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Changes since version 8.0.1:

- The resource metadata has changed (description)

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | observation-vitalsigns | US Core Vital Signs Profile Constraints: obs-6, obs-7, vs-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding | S Σ | 1..* | Coding | Code defined by a terminology system
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from observation-vitalsigns

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | observation-vitalsigns | US Core Vital Signs Profile
status | S | 1..1 | code | registered | preliminary | final | amended +
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation
coding | S | 1..* | Coding | Code defined by a terminology system
system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S | 1..1 |  | Often just a dateTime for Vital Signs
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S | 0..1 | CodeableConcept | Why the result is missing
component | S | 0..* | BackboneElement | Component observations
code | S | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S | 0..1 | CodeableConcept | Why the component result is missing
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | observation-vitalsigns | US Core Vital Signs Profile Constraints: obs-6, obs-7, vs-2
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for observation
basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Fulfills plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Part of referenced event
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | S Σ | 1..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 0..* | Annotation | Comments about the observation
bodySite |  | 0..1 | CodeableConcept | Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen |  | 0..1 | Reference(Specimen) | Specimen used for this observation
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
referenceRange | C | 0..* | BackboneElement | Provides guide for interpretation Constraints: obs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
low | C | 0..1 | SimpleQuantity(4.0.1) | Low Range, if relevant
high | C | 0..1 | SimpleQuantity(4.0.1) | High Range, if relevant
type |  | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo |  | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age |  | 0..1 | Range | Applicable age range, if relevant
text |  | 0..1 | string | Text based reference range in an observation
hasMember | Σ | 0..* | Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Used when reporting vital signs panel components
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Related measurements the observation is made from
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange |  | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📍4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from observation-vitalsigns

Summary

Mandatory: 5 elements
Must-Support: 16 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Slices

This structure defines the following Slices:

- The element 2 is sliced based on the values of Observation.category

Maturity: 5

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | observation-vitalsigns | US Core Vital Signs Profile Constraints: obs-6, obs-7, vs-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding | S Σ | 1..* | Coding | Code defined by a terminology system
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

Differential View

This structure is derived from observation-vitalsigns

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | observation-vitalsigns | US Core Vital Signs Profile
status | S | 1..1 | code | registered | preliminary | final | amended +
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation
coding | S | 1..* | Coding | Code defined by a terminology system
system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
code | S | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
effective[x] | S | 1..1 |  | Often just a dateTime for Vital Signs
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
performer | S | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S | 0..1 | CodeableConcept | Why the result is missing
component | S | 0..* | BackboneElement | Component observations
code | S | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S | 0..1 | CodeableConcept | Why the component result is missing
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | observation-vitalsigns | US Core Vital Signs Profile Constraints: obs-6, obs-7, vs-2
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for observation
basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Fulfills plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Part of referenced event
status | ?!S Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required)
Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | S Σ | 1..* | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: vital-signs
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ C | 1..1 |  | Often just a dateTime for Vital Signs Constraints: vs-1
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile) | Who is responsible for the observation
value[x] | S Σ C | 0..1 |  | Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 0..* | Annotation | Comments about the observation
bodySite |  | 0..1 | CodeableConcept | Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen |  | 0..1 | Reference(Specimen) | Specimen used for this observation
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
referenceRange | C | 0..* | BackboneElement | Provides guide for interpretation Constraints: obs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
low | C | 0..1 | SimpleQuantity(4.0.1) | Low Range, if relevant
high | C | 0..1 | SimpleQuantity(4.0.1) | High Range, if relevant
type |  | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo |  | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age |  | 0..1 | Range | Applicable age range, if relevant
text |  | 0..1 | string | Text based reference range in an observation
hasMember | Σ | 0..* | Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Used when reporting vital signs panel components
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile) | Related measurements the observation is made from
component | S Σ C | 0..* | BackboneElement | Component observations Constraints: vs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 1..1 | CodeableConcept | Coded vital sign result type Binding: Vital Sign Result Type (extensible): Vital sign result types
value[x] | S Σ C | 0..1 |  | Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | S C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange |  | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Observation.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
Observation.category | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.category:VSCat | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📍4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📍4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📍4.0.1 | FHIR Std.
Observation.component.​code | Base | extensible | Vital Sign Result Type | ⏿20251202 | tx.fhir.org
Observation.component.​value[x] | Base | extensible | Vital Signs Units | 📍4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
vs-1 | error | Observation.effective[x] | if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day | `$this is dateTime implies $this.toString().length() >= 10`
vs-2 | error | Observation | If there is no component or hasMember element then either a value[x] or a data absent reason must be present. | `(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())`
vs-3 | error | Observation.component | If there is no a value a data absent reason must be present | `value.exists() or dataAbsentReason.exists()`

This structure is derived from observation-vitalsigns

Summary

Mandatory: 5 elements
Must-Support: 16 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Slices

This structure defines the following Slices:

- The element 2 is sliced based on the values of Observation.category

Maturity: 5

Other representations of profile: CSV, Excel, Schematron

### Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

- See the Scopes Format section for a description of the SMART scopes syntax.
- See the Search Syntax section for a description of the US Core search syntax.
- See the General Requirements section for additional rules and expectations when a Server requires status parameters.
- See the General Guidance section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to vital signs data SHALL support these US Core SMART Scopes:

- resource level scopes: `<patient|user|system>/Observation.rs` §

- granular scopes: `<patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs` §

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all Observations using the combination of the patient and category search parameters

   `GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]`

   Example:

   > 1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and a category code = "vital-signs" ( see how to search by reference and how to search by token).

2. SHALL support searching for all Observations by code using the combination of the patient and code search parameters

   - Including optional support OR search on `code` (e.g.`code={system|}[code],{system|}[code],...`)

   `GET [base]/Observation?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}`

   Examples:

   > 1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|8867-4

   > 2. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The US Core Vital Signs Profile "code" parameter searches only `.code` and not `component.code`. ( see how to search by reference and how to search by token).

3. SHALL support searching for all Observations by date (for example, results after 2018) using the combination of the patient and category and date search parameters

   - Including optional support for AND search on `date` (e.g.`date=[date]&date=[date]&...`)

   - Including support for these `date` comparators: "gt", "lt", "ge", "le"

   `GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`

   Example:

   > 1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2018-03-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and date and a category code = "vital-signs" ( see how to search by reference and how to search by token and how to search by date).

#### Optional Search Parameters:

The following search parameters and search parameter combinations SHOULD be supported

1. SHOULD support searching for all Observations for a patient for a given status (for example all observations marked as final) using the combination of the patient and category and status search parameters

   - Including support OR search on `status` (e.g.`status={system|}[code],{system|}[code],...`)

   `GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&status={system|}[search_code]{,{system|}[code],...}`

   Example:

   > 1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and category = "vital-signs" and status ( see how to search by reference and how to search by token).

2. SHOULD support searching using the combination of the patient and category and _lastUpdated search parameters

   - Including optional support for AND search on `_lastUpdated` (e.g.`_lastUpdated=[date]&_lastUpdated=[date]&...`)

   - Including support for these `_lastUpdated` comparators: "gt", "lt", "ge", "le"

   `GET [base]/Observation?patient={Patient/}[id]&category={system|}[search_code]&_lastUpdated=[dateTime]`

   Example:

   > 1. GET [base]/Observation?patient=Patient/1137192&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and category code = "vital-signs" and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. ( see how to search by reference and how to search by token and how to search by date).

3. SHOULD support searching Observations by code and date using the combination of the patient and code and date search parameters

   - Including optional support OR search on `code` (e.g.`code={system|}[code],{system|}[code],...`)

   - Including optional support for AND search on `date` (e.g.`date=[date]&date=[date]&...`)

   - Including support for these `date` comparators: "gt", "lt", "ge", "le"

   `GET [base]/Observation?patient={Patient/}[id]&code={system|}[search_code]{,{system|}[code],...}&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`

   Example:

   > 1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|8867-4&date=ge2019-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all US Core Vital Signs Profile resources for the specified patient and date and code(s). SHOULD support search by multiple codes. ( see how to search by reference and how to search by token and how to search by date).