# US Core Observation Screening Assessment Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Observation Screening Assessment Profile**

## Resource Profile: US Core Observation Screening Assessment Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 3 | *Computable Name*:USCoreObservationScreeningAssessmentProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.47 | | |

 
The US Core Observation Screening Assessment Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. Beginning with US Core Version 6.0.0, this profile supersedes the US Core Observation Survey Profile (see the [Changes Between Versions](changes-between-versions.md) page for a summary of cross-version comparisons of US Core Profiles). This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) **Health Status Assessments** Data Class. It sets the minimum expectations for the Observation Resource to record, search, and fetch observations representing the questions and responses to surveys and screening and assessment tools. For example, a social history status such as education or food insecurity or an assessment of cognitive, functional, or disability status. It can represent a single response, multiple responses, and multi-select "check all that apply" type questions. This profile 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. Before reviewing this profile, implementers are encouraged to read the Screening and Assessments guidance page, which documents the process of recording responses and capturing assertions/determinations resulting from surveys and questionnaires. 

**Example Usage Scenarios:**

The following are example usage scenarios for this profile:

* Query for screening or assessment results for a patient.
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) screening and assessment results belonging to a Patient

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile-specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

1. a status
1. a category code of "survey"
1. a[LOINC](http://loinc.org)code, if available, which tells you the survey question
1. a patient

**Each Observation Must Support:**

1. a time indicating when the survey was taken
1. the answer or a reason why the data is absent1
* if the result value is a numeric quantity and coded quantity units are used, [UCUM](http://unitsofmeasure.org) is required.

1. who answered the questions (in other words, a performer)2
1. related questionnaire responses or observations that this observation is made from
1. reference to observations that make up this observation3

**Additional USCDI Requirements:**

This [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) element is not Mandatory or Must Support but is required for ONC Health IT certification testing and is included in the formal definition of the profile and the Observation examples.

1. additional categories that further specify the assessment or screening4

1,2,3,4 see guidance below

### Profile Specific Implementation Guidance

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

* 1See the [Screening and Assessments](screening-and-assessments.md) guidance page for how this profile represents surveys, screenings, and assessments. 
* Each response to individual questions and each answer to a multi-select or "check all that apply" question is a separate US Core Screening and Assessments Observation. The question is communicated in `Observation.code`, and the answer is in `Observation.value`.
* Multi-question screenings and assessments use the US Core Screening and Assessments Observation to represent a "panel" or grouping. The multi-question surveys or assessments `Observation.code` is an overarching assessment or screening code, and the `Observation.value` element **SHOULD** be empty.[§](requirements.md#CONF-0437) `Observation.hasMember` references US Core Screening and Assessments Observations that represent the responses to each question in the screening or assessment.
 
* A practitioner's clinical observation or assertion about a patient's health status, which is not a response to a screening or assessment question, **SHOULD** use the [US Core Simple Observation Profile](StructureDefinition-us-core-simple-observation.md) instead.[§](requirements.md#CONF-0438)
* 4The category type "survey" is required, and, at a minimum, Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category](ValueSet-us-core-screening-assessment-observation-category.md) codes,[§](requirements.md#CONF-0845),[§](requirements.md#CONF-0846) **SHOULD** support the other [US Core Screening Assessment Observation Maximum Category](ValueSet-us-core-screening-assessment-observation-maximum-category.md) codes,[§](requirements.md#CONF-0847) and **MAY** support other categories.[§](requirements.md#CONF-0848)
* 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`.[§](requirements.md#CONF-0427),[§](requirements.md#CONF-0428) 
* For further guidance, see the [Observation Grouping](http://hl7.org/fhir/R4/observation.html#obsgrouping) section in FHIR Specification.
* Systems that never provide an observation without a value **MAY** choose not to support `Observation.dataAbsentReason`.[§](requirements.md#CONF-0429)
 
* 1An `Observation.component` without a value, **SHALL** include a reason why the data is absent.[§](requirements.md#CONF-0425) 
* Systems that never provide a component observation without a component value **MAY** choose not to support `Observation.component.dataAbsentReason`.[§](requirements.md#CONF-0426)
 

* 2The profile elements `Observation.performer and Observation.device` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.
* 3Although 'Observation.derivedFrom' target profiles [US Core Observation Screening Assessment Profile](StructureDefinition-us-core-observation-screening-assessment.md) and [US Core QuestionnaireResponse Profile](StructureDefinition-us-core-questionnaireresponse.md) are labeled **Must Support**. Servers are not required to support both, but **SHALL** support at least one.[§](requirements.md#CONF-0439) The Client application **SHALL** support both.[§](requirements.md#CONF-0849)

**Usages:**

* Refer to this Profile: [US Core Observation Screening Assessment Profile](StructureDefinition-us-core-observation-screening-assessment.md)
* Examples for this Profile: [Observation/10-minute-apgar-color](Observation-10-minute-apgar-color.md), [Observation/10-minute-apgar-heart-rate](Observation-10-minute-apgar-heart-rate.md), [Observation/10-minute-apgar-muscle-tone](Observation-10-minute-apgar-muscle-tone.md), [Observation/10-minute-apgar-reflex-irritability](Observation-10-minute-apgar-reflex-irritability.md)... Show 46 more, [Observation/10-minute-apgar-respiratory-effort](Observation-10-minute-apgar-respiratory-effort.md), [Observation/10-minute-apgar-score-panel](Observation-10-minute-apgar-score-panel.md), [Observation/10-minute-apgar-score](Observation-10-minute-apgar-score.md), [Observation/AHC-HRSN-item-example-68517-2](Observation-AHC-HRSN-item-example-68517-2.md), [Observation/AUDIT-C-item-example-68517-2](Observation-AUDIT-C-item-example-68517-2.md), [Observation/AUDIT-C-item-example-68519-8](Observation-AUDIT-C-item-example-68519-8.md), [Observation/AUDIT-C-item-example-68520-6](Observation-AUDIT-C-item-example-68520-6.md), [Observation/AUDIT-C-item-example-75626-2](Observation-AUDIT-C-item-example-75626-2.md), [Observation/AUDIT-C-panel-example-72109-2](Observation-AUDIT-C-panel-example-72109-2.md), [Observation/EVS-item-example-68516-4](Observation-EVS-item-example-68516-4.md), [Observation/EVS-item-example-89555-7](Observation-EVS-item-example-89555-7.md), [Observation/EVS-panel-example-89574-8](Observation-EVS-panel-example-89574-8.md), [Observation/HVS-item-example-88122-7](Observation-HVS-item-example-88122-7.md), [Observation/HVS-item-example-88123-5](Observation-HVS-item-example-88123-5.md), [Observation/HVS-item-example-88124-3](Observation-HVS-item-example-88124-3.md), [Observation/HVS-panel-example-88121-9](Observation-HVS-panel-example-88121-9.md), [Observation/PHQ9-item-example-44250-9](Observation-PHQ9-item-example-44250-9.md), [Observation/PHQ9-item-example-44251-7](Observation-PHQ9-item-example-44251-7.md), [Observation/PHQ9-item-example-44252-5](Observation-PHQ9-item-example-44252-5.md), [Observation/PHQ9-item-example-44253-3](Observation-PHQ9-item-example-44253-3.md), [Observation/PHQ9-item-example-44254-1](Observation-PHQ9-item-example-44254-1.md), [Observation/PHQ9-item-example-44255-8](Observation-PHQ9-item-example-44255-8.md), [Observation/PHQ9-item-example-44258-2](Observation-PHQ9-item-example-44258-2.md), [Observation/PHQ9-item-example-44259-0](Observation-PHQ9-item-example-44259-0.md), [Observation/PHQ9-item-example-44260-8](Observation-PHQ9-item-example-44260-8.md), [Observation/PHQ9-item-example-44261-6](Observation-PHQ9-item-example-44261-6.md), [Observation/PHQ9-item-example-69722-7](Observation-PHQ9-item-example-69722-7.md), [Observation/PHQ9-panel-example-44249-1](Observation-PHQ9-panel-example-44249-1.md), [Observation/PRAPARE-item-example-54899-0](Observation-PRAPARE-item-example-54899-0.md), [Observation/PRAPARE-item-example-56051-6](Observation-PRAPARE-item-example-56051-6.md), [Observation/PRAPARE-item-example-56799-0](Observation-PRAPARE-item-example-56799-0.md), [Observation/PRAPARE-item-example-63512-8](Observation-PRAPARE-item-example-63512-8.md), [Observation/PRAPARE-item-example-63586-2](Observation-PRAPARE-item-example-63586-2.md), [Observation/PRAPARE-item-example-67875-5](Observation-PRAPARE-item-example-67875-5.md), [Observation/PRAPARE-item-example-71802-3](Observation-PRAPARE-item-example-71802-3.md), [Observation/PRAPARE-item-example-76437-3](Observation-PRAPARE-item-example-76437-3.md), [Observation/PRAPARE-item-example-76501-6](Observation-PRAPARE-item-example-76501-6.md), [Observation/PRAPARE-item-example-82589-3](Observation-PRAPARE-item-example-82589-3.md), [Observation/PRAPARE-item-example-93026-3](Observation-PRAPARE-item-example-93026-3.md), [Observation/PRAPARE-item-example-93027-1](Observation-PRAPARE-item-example-93027-1.md), [Observation/PRAPARE-item-example-93028-9](Observation-PRAPARE-item-example-93028-9.md), [Observation/PRAPARE-item-example-93029-7](Observation-PRAPARE-item-example-93029-7.md), [Observation/PRAPARE-item-example-93030-5](Observation-PRAPARE-item-example-93030-5.md), [Observation/PRAPARE-item-example-93033-9](Observation-PRAPARE-item-example-93033-9.md), [Observation/PRAPARE-item-example-93034-7](Observation-PRAPARE-item-example-93034-7.md) and [Observation/PRAPARE-item-example-93035-4](Observation-PRAPARE-item-example-93035-4.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.core|current/StructureDefinition/StructureDefinition-us-core-observation-screening-assessment.json)

**Changes since version 8.0.1:**

* The resource metadata has changed (description, copyright)

* One or more text definitions, invariants or bindings have changed

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-observation-screening-assessment.csv), [Excel](StructureDefinition-us-core-observation-screening-assessment.xlsx), [Schematron](StructureDefinition-us-core-observation-screening-assessment.sch) 

### 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](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to assessment data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/Observation.rs` [§](requirements.md#CONF-0145)
* [granular scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#finer-grained-resource-constraints-using-search-parameters): `<patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|survey` [§](requirements.md#CONF-0164)
* [granular scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#finer-grained-resource-constraints-using-search-parameters): `<patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|sdoh` [§](requirements.md#CONF-0161)

-------

#### 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](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) 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|survey

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and a category code = "survey" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by code using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [code](SearchParameter-us-core-observation-code.md) 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|9271-8
1. GET [base]/Observation?patient=Patient/1137192&code=http://loinc.org|9271-8,http://loinc.org|32405-3,http://loinc.org|32403-8

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The US Core Observation Screening Assessment Profile "code" parameter searches only `.code` and not `component.code`. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHALL** support searching for all Observations by date (for example, results after 2018) using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [date](SearchParameter-us-core-observation-date.md) 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|survey&date=ge2018-03-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and date and a category code = "survey" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#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](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [status](SearchParameter-us-core-observation-status.md) 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|survey&status=final

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and category = "survey" and status ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [category](SearchParameter-us-core-observation-category.md) and [_lastUpdated](SearchParameter-us-core-observation-lastupdated.md) 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|survey&_lastUpdated=ge2024-01-01T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and category code = "survey" and _lastUpdated. See the US Core General Guidance page for [Searching Using lastUpdated](general-guidance.md#searching-using-lastupdated). ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).
1. **SHOULD** support searching Observations by code and date using the combination of the [patient](SearchParameter-us-core-observation-patient.md) and [code](SearchParameter-us-core-observation-code.md) and [date](SearchParameter-us-core-observation-date.md) 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|9271-8&date=ge2019-01-01T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Observation Screening Assessment Profile resources for the specified patient and date and code(s). SHOULD support search by multiple codes. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-observation-screening-assessment",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 3
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.47"
  }],
  "version" : "9.0.0",
  "name" : "USCoreObservationScreeningAssessmentProfile",
  "title" : "US Core Observation Screening Assessment Profile",
  "status" : "active",
  "date" : "2024-11-16",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core Observation Screening Assessment Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. Beginning with US Core Version 6.0.0, this profile supersedes the US Core Observation Survey Profile (see the [Changes Between Versions](changes-between-versions.html) page for a summary of cross-version comparisons of US Core Profiles).  This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) *Health Status Assessments* Data Class. It sets the minimum expectations for the Observation Resource to record, search, and fetch observations representing the questions and responses to surveys and screening and assessment tools. For example, a social history status such as education or food insecurity or an assessment of cognitive, functional, or disability status. It can represent a single response, multiple responses, and multi-select \"check all that apply\" type questions. This profile 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. Before reviewing this profile, implementers are encouraged to read the Screening and Assessments guidance page, which documents the process of recording responses and capturing assertions/determinations resulting from surveys and questionnaires.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "sct-concept",
    "uri" : "http://snomed.info/conceptdomain",
    "name" : "SNOMED CT Concept Domain Binding"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "sct-attr",
    "uri" : "http://snomed.org/attributebinding",
    "name" : "SNOMED CT Attribute Binding"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Observation",
      "path" : "Observation",
      "short" : "Survey Observation",
      "constraint" : [{
        "key" : "us-core-2",
        "severity" : "error",
        "human" : "If there is no component or hasMember element then either a value[x] or a data absent reason must be present",
        "expression" : "(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())",
        "xpath" : "exists(f:component) or exists(f:hasMember) or exists(f:*[starts-with(local-name(.), 'value')]) or exists(f:dataAbsentReason)"
      }]
    },
    {
      "id" : "Observation.status",
      "path" : "Observation.status",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category",
      "path" : "Observation.category",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "$this"
        }],
        "rules" : "open"
      },
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "Observation.category:survey",
      "path" : "Observation.category",
      "sliceName" : "survey",
      "requirements" : "Used for filtering if the observation is an assessment or screening.",
      "min" : 1,
      "max" : "1",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
          "code" : "survey"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.category:screening-assessment",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Observation.category",
      "sliceName" : "screening-assessment",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class",
      "definition" : "Categories that a provider may use in their workflow to classify that this Observation is related to a USCDI Health Status/Assessments Data Class.",
      "requirements" : "Used for filtering the type of screening or assessment observation.",
      "mustSupport" : false,
      "binding" : {
        "extension" : [{
          "extension" : [{
            "url" : "key",
            "valueId" : "us-core-screening-assessment-observation-category"
          },
          {
            "url" : "purpose",
            "valueCode" : "minimum"
          },
          {
            "url" : "valueSet",
            "valueCanonical" : "http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-observation-category"
          },
          {
            "url" : "documentation",
            "valueMarkdown" : "codes that any certifying system SHALL support to help identify the type of USCDI Health Status/Assessments data class' data elements being reported."
          },
          {
            "url" : "shortDoco",
            "valueString" : "USCDI Health Status/Assessments Data Elements"
          }],
          "url" : "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
        }],
        "strength" : "required",
        "description" : "Note that other codes are permitted in other slices, see [Required Bindings When Slicing by Value Sets](general-requirements.html#required-bindings-when-slicing-by-valuesets)",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-observation-maximum-category"
      }
    },
    {
      "id" : "Observation.code",
      "path" : "Observation.code",
      "mustSupport" : true,
      "binding" : {
        "strength" : "preferred",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.13"
      }
    },
    {
      "id" : "Observation.subject",
      "path" : "Observation.subject",
      "min" : 1,
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/Group",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-device",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.effective[x]",
      "path" : "Observation.effective[x]",
      "definition" : "The time or time-period the observed value is asserted as being true. For biological subjects - e.g., human patients - this is usually called the \"physiologically relevant time\".",
      "comment" : "At least a date should be present unless this observation is a historical report.",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      },
      {
        "code" : "Timing"
      },
      {
        "code" : "instant"
      }],
      "condition" : ["us-core-1"],
      "constraint" : [{
        "key" : "us-core-1",
        "severity" : "error",
        "human" : "Datetime must be at least to day.",
        "expression" : "$this is dateTime implies $this.toString().length() >= 10",
        "xpath" : "f:matches(effectiveDateTime,/\\d{4}\\d{2}\\d{2}(T\\d{2}:\\d{2}:\\d{2}(\\.\\d{3})?(Z|[-+]\\d{2}:\\d{2})?)?$/)"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.performer",
      "path" : "Observation.performer",
      "comment" : "Some questions on questionnaires are not answered directly (e.g., asserted) by the individual completing the questionnaire, but are derived from answers to one or more other questions. For types of answers, `Observation.performer` should not be specified and `Observation.derivedFrom` should reference the relevant Screening Response Observation(s).",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.value[x]",
      "path" : "Observation.value[x]",
      "comment" : "An observation may have a value if it represents an individual survey, screening, or assessment question and answer pair. An observation should not have a value if it represents a multi-question or multi-select “check all that apply” responses. If a value is present, the datatype for this element should be determined by Observation.code.  A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "Quantity"
      },
      {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "CodeableConcept"
      },
      {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "string"
      },
      {
        "code" : "boolean"
      },
      {
        "code" : "integer"
      },
      {
        "code" : "Range"
      },
      {
        "code" : "Ratio"
      },
      {
        "code" : "SampledData"
      },
      {
        "code" : "time"
      },
      {
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      }],
      "condition" : ["us-core-2", "us-core-3"],
      "constraint" : [{
        "key" : "us-core-3",
        "severity" : "error",
        "human" : "The system SHALL be UCUM for coded quantity units.",
        "expression" : "ofType(Quantity).system.empty() or ofType(Quantity).system = 'http://unitsofmeasure.org'",
        "xpath" : "not(exists(f:valueQuantity/f:system) ) or f:valueQuantity/f:system[@value='http://unitsofmeasure.org']"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.dataAbsentReason",
      "path" : "Observation.dataAbsentReason",
      "comment" : "\"Null\" or exceptional values can be represented two ways in FHIR Observations.  One way is to simply include them in the value set and represent the exceptions in the value.  The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For a given LOINC question, if the LOINC answer list includes concepts such as 'unknown' or 'not available', they should be used for Observation.value. Where these concepts are not part of the value set for Observation.value, the Observation.dataAbsentReason can be used if necessary and appropriate.",
      "condition" : ["us-core-2"],
      "mustSupport" : true
    },
    {
      "id" : "Observation.hasMember",
      "path" : "Observation.hasMember",
      "short" : "Reference to panel members or multi-select responses or multi-select responses",
      "definition" : "Aggregate set of Observations that represent question answer pairs for both multi-question surveys, screenings, and assessments and multi-select questions.",
      "comment" : "This grouping element is used to represent surveys, screenings, and assessments that group several questions together or individual questions with  “check all that apply” responses. For example in the simplest case a flat multi-question survey where the \"panel\" observation is the survey instrument itself and instead of an `Observation.value` the `hasMember` element references other Observation that represent the individual questions answer pairs. When there is a heirarchical grouping of questions, the observation \"panels\" can be nested. Because surveys, screenings, and assessments can be arbitrarily complex structurally, not all structures can be represented using this Observation grouping pattern.",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment",
        "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse",
        "http://hl7.org/fhir/StructureDefinition/MolecularSequence"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.derivedFrom",
      "path" : "Observation.derivedFrom",
      "definition" : "Observations or or other resource such as a QuestionnaireResponse from which this observation value is derived.",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference",
        "http://hl7.org/fhir/StructureDefinition/ImagingStudy",
        "http://hl7.org/fhir/StructureDefinition/Media",
        "http://hl7.org/fhir/StructureDefinition/MolecularSequence"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    }]
  }
}

```
