

**Example Usage Scenarios:**

The following are example usage scenarios for this profile:

- Query for average blood pressure observations belonging to a patient
- [Record or update] average blood pressure observations belonging to a patient

### 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.

**Each Observation Must Have:**

1. a status
2. a category code of "vital-signs"
3. a fixed code for average systolic and diastolic blood pressure panel
4. a fixed *component* code for average systolic blood pressure
5. a fixed *component* code for average diastolic blood pressure
6. a patient
7. clinically relevant time-period for the average of blood pressure readings

**Each Observation Must Support:**

1. a performer<sup>1</sup>
3. a result value for the average systolic blood pressure
4. a result value for the average diastolic blood pressure
5. a reason if the value is absent<sup>2</sup>

<sup>1,2</sup> see guidance below

### Profile Specific Implementation Guidance

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

- The category "vital-signs" aligns with the USCDI Data Class and Elements and provides a convenient and consistent grouping of the clinical concepts. Implementers can group them differently based on their clinical needs.
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- <sup>2</sup>Because the blood pressure values are communicated in the *mandatory* systolic and diastolic components:
  - the `Observation.value[x]` element **SHALL** be omitted.<sup>[§][CONF-0421]</sup>
  - An Observation without a systolic or diastolic result value **SHALL** include a reason why the data is absent in `Observation.component.dataAbsentReason`
  - *All Server systems* - including those that never provide a component observation without a value - **SHALL** support `Observation.component.dataAbsentReason` for the components.
- This Profile is not dependent on any specific protocol. Information about the protocol used **SHOULD** be supplied in either:
  - `Observation.note.text` (for example, "Average blood pressure is calculated from 12 measurements taken by the patient over three days.")
  - The standard FHIR extension <http://hl7.org/fhir/StructureDefinition/workflow-adheresTo>
- Information about the number of measurements used to determine the average **SHOULD** be supplied as an `Observation.component` using the SNOMED CT code "246432004 \| Number of occurrences (qualifier value)". The example shows how this component can be used.
- The observation **MAY** use an [extension] defined by other profiles such as [Vital Signs with Qualifying Elements: Average Blood Pressure Profile].

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