# MII PR Person Vitalstatus - MII Implementation Guide Core Dataset Base v2026.0.0

## Ressourcenprofil: MII PR Person Vitalstatus 

 
Vitalstatus einer Patientin oder eines Patienten. 

**Beispielhafte Anwendungsszenarien:**

* Dokumentation des Vitalstatus (lebend/verstorben) einer PatientIn zu bestimmten Zeitpunkten
* Nachverfolgung des letzten bekannten Lebenszeitpunktes für PatientInnen in klinischen und Forschungskontexten
* Erfassung von Vitalstatus-Observationen bei jeder Krankenhausaufnahme und Entlassung
* Unterstützung von Mortalitätsanalysen und Überlebensstudien in Forschungsanwendungen
* Pflege der Vitalstatus-Historie durch mehrere Observation-Instanzen über die Zeit

### Profilspezifische Implementierungshinweise

Dieser Abschnitt enthält detaillierte Implementierungshinweise für das MII-Vitalstatus-Profil.

#### Anforderungen an Observation-Instanzen

**Mehrere Observationen:**

* Für jede Beobachtung/Angabe des Vitalstatus einer PatientIn **MUSS** eine **neue** Observation-Instanz erzeugt werden
* Alle Observation-Instanzen **MÜSSEN** `status='final'` haben
* Jede Instanz repräsentiert eine zeitpunktbezogene Aussage über den Vitalstatus der PatientIn

**Häufigkeit der Dokumentation:**

* Der Vitalstatus ("letzter bekannter Lebenszeitpunkt") **SOLLTE** mindestens bei jeder Aufnahme/Entlassung anlassbezogen als Observation erstellt werden
* Die Häufigkeit der Erhebung ist ansonsten nicht weiter geregelt und kann variieren
* Die Quelldaten sind oft nur schwer zu erschließen und erfordern möglicherweise manuelle Recherche (z.B. Kontaktaufnahme, öffentliche Informationen wie Todesanzeigen)

##### Best Practice - Datenquellen für Vitalstatus

**Administrative Entlassung:** Die administrative Entlassung der PatientIn aufgrund des Todes **SOLLTE** dokumentiert werden (siehe Modul Fall - Entlassungsgrund) und **KANN** als nützliche Datenquelle für den Vitalstatus dienen.

**Integration:** Systeme sollten Workflows etablieren, um automatisch Vitalstatus-Observationen zu erstellen, wenn der Entlassungsgrund auf Tod hinweist, um Konsistenz zwischen administrativer und klinischer Dokumentation zu gewährleisten.

**Manuelle Recherche:** In Fällen, in denen der Vitalstatus unklar ist, kann manuelle Recherche notwendig sein (Kontaktversuche, öffentliche Aufzeichnungen). Dokumentieren Sie die Informationsquelle angemessen in zugehörigen Metadaten (Provenance-Ressource).

#### Verpflichtende Elemente

**Feste Werte:**

* **`Observation.category`**: Fester Wert `survey` **MUSS** vorhanden sein; weitere Codings sind OPTIONAL
* **`Observation.code`**: Fester LOINC-Code `67162-8` (Vitalstatus [Minimum Data Set]) **MUSS** vorhanden sein; weitere Codings sind OPTIONAL

**Patientenbezug:**

* **`Observation.subject`**: Referenz auf Patient **MUSS** stets gegeben sein
* Der Vitalstatus ist inhärent patientenspezifisch und kann ohne diese Referenz nicht existieren

**Effective DateTime:**

* **`Observation.effectiveDateTime`**: VERPFLICHTEND genaue Angabe des letzten Lebendzeitpunktes 
* **KANN** partielle Datumsangaben enthalten (Jahr, Jahr-Monat), wenn das genaue Datum unbekannt ist
* Enthält **nicht** den Todeszeitpunkt (siehe `Patient.deceased[x]` für die Dokumentation des Todes)
* Repräsentiert den Zeitpunkt, zu dem die PatientIn bekanntermaßen im dokumentierten Vitalstatus war
 

##### Best Practice - effectiveDateTime vs. Patient.deceased[x]

**Unterscheidung:** `Observation.effectiveDateTime` repräsentiert den **letzten bekannten Lebendzeitpunkt** oder den Zeitpunkt der Vitalstatus-Feststellung, NICHT den Todeszeitpunkt.

**Dokumentation des Todes:** Verwenden Sie `Patient.deceased[x]` (vorzugsweise `deceasedDateTime`), um den tatsächlichen Todeszeitpunkt zu dokumentieren.

**Beispielszenario:**

* PatientIn lebend entlassen am 15.03.2024 → Vitalstatus-Observation mit `effectiveDateTime = 2024-03-15` und `valueCodeableConcept = "L" (lebend)`
* PatientIn verstorben bestätigt am 20.04.2024 → Aktualisierung `Patient.deceasedDateTime = 2024-04-20` und Erstellung einer neuen Vitalstatus-Observation mit `effectiveDateTime = 2024-04-20` und `valueCodeableConcept = "T" (tot)`

#### Wert-Dokumentation

**`Observation.valueCodeableConcept`:**

* Verwendet Codes aus dem MII Vitalstatus CodeSystem: 
* `L` = lebend
* `T` = tot
* `X` = unbekannt
 

Siehe [Formal Views](#profile) für das vollständige ValueSet-Binding.

**Usages:**

* Examples for this Profile: [Observation/mii-exa-person-observation-vitalstatus-discharge](Observation-mii-exa-person-observation-vitalstatus-discharge.md) and [Observation/mii-exa-person-observation-vitalstatus](Observation-mii-exa-person-observation-vitalstatus.md)
* CapabilityStatements using this Profile: [MII CPS Person CapabilityStatement](CapabilityStatement-mii-cps-person-capabilitystatement.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/de.medizininformatikinitiative.kerndatensatz.base|current/StructureDefinition/mii-pr-person-vitalstatus)

### Formale Ansichten des Profilinhalts

 [Beschreibung von Profilen, Differentials, Snapshots und deren Repräsentationen](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

*  [Schlüsselelemente-Tabelle](#tabs-key) 
*  [Differential-Tabelle](#tabs-diff) 
*  [Snapshot-Tabelle](#tabs-snap) 
*  [Statistiken/Referenzen](#tabs-summ) 
*  [Alle](#tabs-all) 

#### Terminology Bindings

#### Constraints

Diese Struktur ist abgeleitet von [Observation](http://hl7.org/fhir/R4/observation.html) 

#### Terminology Bindings (Differential)

#### Terminology Bindings

#### Constraints

Diese Struktur ist abgeleitet von [Observation](http://hl7.org/fhir/R4/observation.html) 

**Summary**

Mandatory: 13 elements
 Must-Support: 20 elements
 Fixed: 1 element
 Prohibited: 4 elements

**Slices**

This structure defines the following [Slices](http://hl7.org/fhir/R4/profiling.html#slices):

* The element 1 is sliced based on the value of Observation.category
* The element 1 is sliced based on the value of Observation.code.coding
* The element 1 is sliced based on the value of Observation.value[x].coding

 **Schlüsselelemente-Ansicht** 

#### Terminology Bindings

#### Constraints

 **Differential-Ansicht** 

Diese Struktur ist abgeleitet von [Observation](http://hl7.org/fhir/R4/observation.html) 

#### Terminology Bindings (Differential)

 **Snapshot-AnsichtView** 

#### Terminology Bindings

#### Constraints

Diese Struktur ist abgeleitet von [Observation](http://hl7.org/fhir/R4/observation.html) 

**Summary**

Mandatory: 13 elements
 Must-Support: 20 elements
 Fixed: 1 element
 Prohibited: 4 elements

**Slices**

This structure defines the following [Slices](http://hl7.org/fhir/R4/profiling.html#slices):

* The element 1 is sliced based on the value of Observation.category
* The element 1 is sliced based on the value of Observation.code.coding
* The element 1 is sliced based on the value of Observation.value[x].coding

 

Weitere Repräsentationen des Profils: [CSV](../StructureDefinition-mii-pr-person-vitalstatus.csv), [Excel](../StructureDefinition-mii-pr-person-vitalstatus.xlsx), [Schematron](../StructureDefinition-mii-pr-person-vitalstatus.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "mii-pr-person-vitalstatus",
  "extension" : [
    {
      "url" : "https://www.medizininformatik-initiative.de/fhir/modul-meta/StructureDefinition/mii-ex-meta-license-codeable",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/spdx-license",
            "code" : "CC-BY-4.0",
            "display" : "Creative Commons Attribution 4.0 International"
          }
        ]
      }
    }
  ],
  "url" : "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Vitalstatus",
  "version" : "2026.0.0",
  "name" : "MII_PR_Person_Vitalstatus",
  "title" : "MII PR Person Vitalstatus",
  "_title" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de-DE"
          },
          {
            "url" : "content",
            "valueString" : "Vitalstatus"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      },
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "en-US"
          },
          {
            "url" : "content",
            "valueString" : "Vital status"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "status" : "active",
  "date" : "2025-12-12",
  "publisher" : "Medical Informatics Initiative (MII)",
  "_publisher" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de"
          },
          {
            "url" : "content",
            "valueString" : "Medizininformatik-Initiative (MII)"
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "contact" : [
    {
      "name" : "Medical Informatics Initiative (MII)",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.medizininformatik-initiative.de/en"
        }
      ]
    }
  ],
  "description" : "Dieses Profil beschreibt den Vitalstatus der Patient*in in der Medizininformatik-Initiative.",
  "_description" : {
    "extension" : [
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "de-DE"
          },
          {
            "url" : "content",
            "valueString" : "Vitalstatus einer Patientin oder eines Patienten."
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      },
      {
        "extension" : [
          {
            "url" : "lang",
            "valueCode" : "en-US"
          },
          {
            "url" : "content",
            "valueString" : "Vital status of a patient."
          }
        ],
        "url" : "http://hl7.org/fhir/StructureDefinition/translation"
      }
    ]
  },
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "DE",
          "display" : "Germany"
        }
      ]
    }
  ],
  "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"
      },
      {
        "id" : "Observation.id",
        "path" : "Observation.id",
        "mustSupport" : true
      },
      {
        "id" : "Observation.meta",
        "path" : "Observation.meta",
        "mustSupport" : true
      },
      {
        "id" : "Observation.meta.profile",
        "path" : "Observation.meta.profile",
        "mustSupport" : true
      },
      {
        "id" : "Observation.status",
        "path" : "Observation.status",
        "short" : "Status",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Status"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Status"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "abgeschlossen",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "abgeschlossen"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "completed"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "fixedCode" : "final",
        "mustSupport" : true
      },
      {
        "id" : "Observation.category",
        "path" : "Observation.category",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "short" : "Kategorie",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kategorie"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Category"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Klassifikation des Typs der Beobachtung für den Vitalstatus.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Klassifikation des Typs der Beobachtung für den Vitalstatus."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Classification of type of observation for vital status."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.category:survey",
        "path" : "Observation.category",
        "sliceName" : "survey",
        "min" : 1,
        "max" : "1",
        "patternCodeableConcept" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
              "code" : "survey"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code",
        "path" : "Observation.code",
        "short" : "Code",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Code"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Code"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Ein LOINC Code, der die Vitalstatus Beobachtung identifiziert.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Ein LOINC Code, der die Vitalstatus Beobachtung identifiziert."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "A LOINC code identifying the vital status observation."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding",
        "path" : "Observation.code.coding",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc",
        "path" : "Observation.code.coding",
        "sliceName" : "loinc",
        "short" : "LOINC Code",
        "definition" : "LOINC Code für Vitalstatus",
        "min" : 1,
        "max" : "1",
        "patternCoding" : {
          "system" : "http://loinc.org",
          "code" : "67162-8"
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc.system",
        "path" : "Observation.code.coding.system",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.code.coding:loinc.code",
        "path" : "Observation.code.coding.code",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.subject",
        "path" : "Observation.subject",
        "min" : 1,
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Group"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.encounter",
        "path" : "Observation.encounter",
        "short" : "Kontakt (Aufenthaltsbezug)",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kontakt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Encounter"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Kontakt, bei dem der Vitalstatus festgestellt wurde.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Kontakt, bei dem der Vitalstatus festgestellt wurde."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Encounter during which the vital status was determined."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.effective[x]",
        "path" : "Observation.effective[x]",
        "short" : "Zeitpunkt",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Zeitpunkt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Point in time"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Der Zeitpunkt, zu dem der beobachtete Vitalstatus als wahr festgestellt wird.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Der Zeitpunkt, zu dem der beobachtete Vitalstatus als wahr festgestellt wird."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "The time the observed vital status is asserted as being true."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "type" : [
          {
            "code" : "dateTime"
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x]",
        "path" : "Observation.value[x]",
        "short" : "Codierter Wert",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Wert"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Value"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Der codierte Wert für den Vitalstatus.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "lebendig | verstorben | unbekannt"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "alive | deceased | unknown"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "min" : 1,
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding",
        "path" : "Observation.value[x].coding",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "pattern",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus",
        "path" : "Observation.value[x].coding",
        "sliceName" : "Vitalstatus",
        "short" : "Vitalstatus",
        "definition" : "Der Vitalstatus der Person.",
        "min" : 1,
        "max" : "1",
        "mustSupport" : true,
        "binding" : {
          "strength" : "required",
          "valueSet" : "https://www.medizininformatik-initiative.de/fhir/core/modul-person/ValueSet/Vitalstatus"
        }
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus.system",
        "path" : "Observation.value[x].coding.system",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.value[x].coding:Vitalstatus.code",
        "path" : "Observation.value[x].coding.code",
        "min" : 1,
        "mustSupport" : true
      },
      {
        "id" : "Observation.note",
        "path" : "Observation.note",
        "short" : "Hinweis",
        "_short" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Hinweis"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Note"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "definition" : "Zusätzliche Informationen zum Vitalstatus als Freitext.",
        "_definition" : {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "de-DE"
                },
                {
                  "url" : "content",
                  "valueString" : "Zusätzliche Informationen zum Vitalstatus als Freitext."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            },
            {
              "extension" : [
                {
                  "url" : "lang",
                  "valueCode" : "en-US"
                },
                {
                  "url" : "content",
                  "valueString" : "Additional information about the vital status as free text."
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/translation"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.bodySite",
        "path" : "Observation.bodySite",
        "max" : "0"
      },
      {
        "id" : "Observation.specimen",
        "path" : "Observation.specimen",
        "max" : "0"
      },
      {
        "id" : "Observation.referenceRange",
        "path" : "Observation.referenceRange",
        "max" : "0"
      },
      {
        "id" : "Observation.component",
        "path" : "Observation.component",
        "max" : "0"
      }
    ]
  }
}

```
