MII Implementation Guide Core Dataset Base
2026.0.1 - Release Germany

MII Implementation Guide Core Dataset Base - Downloaded Version 2026.0.1 See the Directory of published versions

## Resource Profile: MII PR Person Vitalstatus

Official URL: https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Vitalstatus | Version: 2026.0.1 | Highlight text changes?
Active as of 2026-06-09 | Computable Name: MII_PR_Person_Vitalstatus

Vital status of a patient.

Example Usage Scenarios:

- Document the vital status (alive/deceased) of a patient at specific points in time
- Track the last known alive timepoint for patients in clinical and research contexts
- Record vital status observations at each hospital admission and discharge
- Support mortality analyses and survival studies in research use cases
- Maintain vital status history through multiple observation instances over time

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the MII Vital Status Profile.

#### Observation Instance Requirements

Multiple Observations:

- A new Observation instance MUST be created for each observation/documentation of a patient's vital status
- All Observation instances MUST have `status='final'`
- Each instance represents a point-in-time assertion about the patient's vital status

Frequency of Documentation:

- Vital status ("last known alive timepoint") SHOULD be documented as an event-based Observation at least at each admission/discharge
- Frequency of vital status assessment is otherwise not strictly regulated and may vary
- Source data is often difficult to obtain and may require manual research (e.g., contact attempts, public information such as death notices)

##### Best Practice - Vital Status Data Sources

Administrative Discharge: Administrative discharge of a patient due to death SHOULD be documented (see Fall module - Entlassungsgrund/discharge disposition) and CAN serve as a useful data source for vital status.

Integration: Systems SHOULD establish workflows to automatically create vital status observations when discharge disposition indicates death, ensuring consistency between administrative and clinical documentation.

Manual Research: In cases where vital status is unclear, manual research may be necessary (contact attempts, public records). Document the information source appropriately in associated metadata (Provenance resource).

#### Required Elements

Fixed Values:

- `Observation.category`: Fixed value `survey` MUST be present; additional codings are OPTIONAL
- `Observation.code`: Fixed LOINC code `67162-8` MUST be present; additional codings are OPTIONAL

Patient Reference:

- `Observation.subject`: Reference to Patient MUST always be provided
- Vital status is inherently patient-specific and cannot exist without this reference

Effective DateTime:

- `Observation.effectiveDateTime`: Required precise specification of the last known alive timepoint
  - MAY contain partial date specifications (year, year-month) when exact date is unknown
  - Does NOT represent the time of death (see `Patient.deceased[x]` for death documentation)
  - Represents the point in time when the patient was known to be in the documented vital status

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

Distinction: `Observation.effectiveDateTime` represents the last known alive timepoint or the time when vital status was assessed, NOT the time of death.

Death Documentation: Use `Patient.deceased[x]` (preferably `deceasedDateTime`) to document the actual time of death.

Example Scenario:

- Patient discharged alive on 2024-03-15 → Vital status Observation with `effectiveDateTime = 2024-03-15` and `valueCodeableConcept = "L" (lebend/alive)`
- Patient confirmed deceased on 2024-04-20 → Update `Patient.deceasedDateTime = 2024-04-20` and create new Vital status Observation with `effectiveDateTime = 2024-04-20` and `valueCodeableConcept = "T" (tot/deceased)`

#### Value Documentation

`Observation.valueCodeableConcept`:

- Uses codes from the MII Vitalstatus CodeSystem:
  - `L` = lebend (alive)
  - `T` = tot (deceased)
  - `X` = unbekannt (unknown)

See Formal Views for the complete ValueSet binding.

Usages:

- Examples for this Profile: Observation/mii-exa-person-observation-vitalstatus-discharge and Observation/mii-exa-person-observation-vitalstatus
- CapabilityStatements using this Profile: MII CPS Person CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | Observation | Measurements and simple assertions Constraints: obs-6, obs-7
id | S Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
profile | S Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
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 | Status Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
text |  | 0..1 | string | Plain text representation of the concept
coding | S Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
version |  | 0..1 | string | Version of the system - if relevant
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | S Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
code | S Σ | 1..1 | CodeableConcept | Code Binding: LOINCCodes (example): Codes identifying names of simple observations.
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S Σ | 1..1 | Coding | LOINC Code Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
version |  | 0..1 | string | Version of the system - if relevant
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 67162-8
subject | S Σ | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
encounter | S Σ | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
effective[x] | S Σ | 1..1 | dateTime | Zeitpunkt
value[x] | S Σ C | 1..1 | CodeableConcept | Codierter Wert
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S Σ | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
system | S Σ | 1..1 | uri | Identity of the terminology system
code | S Σ | 1..1 | code | Symbol in syntax defined by the system
note | S | 0..* | Annotation | Hinweis
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:survey | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | example | LOINC Codes | 📍4.0.1 | FHIR Std.
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG
Observation.component.​code | Base | example | LOINC 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-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()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | Observation | Measurements and simple assertions
id | S | 0..1 | id | Logical id of this artifact
meta | S | 0..1 | Meta | Metadata about the resource
profile | S | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
status | S | 1..1 | code | Status Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Required Pattern: At least the following
coding | S | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system | S | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
code | S | 1..1 | CodeableConcept | Code
Slices for coding | S | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S | 1..1 | Coding | LOINC Code Required Pattern: At least the following
system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 67162-8
subject | S | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
reference | S | 0..1 | string | Literal reference, Relative, internal or absolute URL
encounter | S | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
reference | S | 0..1 | string | Literal reference, Relative, internal or absolute URL
effective[x] | S | 1..1 | dateTime | Zeitpunkt
value[x] | S | 1..1 | CodeableConcept | Codierter Wert
Slices for coding | S | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
system | S | 1..1 | uri | Identity of the terminology system
code | S | 1..1 | code | Symbol in syntax defined by the system
note | S | 0..* | Annotation | Hinweis
bodySite |  | 0..0 |  | Observed body part
specimen |  | 0..0 |  | Specimen used for this observation
referenceRange |  | 0..0 |  | Provides guide for interpretation
component |  | 0..0 |  | Component results
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | Observation | Measurements and simple assertions Constraints: obs-6, obs-7
id | S Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | S Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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 | Status Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | S Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | S Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | Code Binding: LOINCCodes (example): Codes identifying names of simple observations.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S Σ | 1..1 | Coding | LOINC Code Required Pattern: At least the following
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://loinc.org
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: 67162-8
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
subject | S Σ | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | S Σ | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
effective[x] | S Σ | 1..1 | dateTime | Zeitpunkt
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) | Who is responsible for the observation
value[x] | S Σ C | 1..1 | CodeableConcept | Codierter Wert
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S Σ | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
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
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system
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
dataAbsentReason | 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 | S | 0..* | Annotation | Hinweis
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) | Related measurements the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
Observation.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
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:survey | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | example | LOINC Codes | 📍4.0.1 | FHIR Std.
Observation.subject.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Observation.encounter.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍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 | example | LOINC Codes | 📍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-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()`

Summary

Mandatory: 13 elements
Must-Support: 25 elements
Fixed: 1 element
Prohibited: 4 elements

Slices

This structure defines the following 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

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | Observation | Measurements and simple assertions Constraints: obs-6, obs-7
id | S Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
profile | S Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
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 | Status Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
text |  | 0..1 | string | Plain text representation of the concept
coding | S Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
version |  | 0..1 | string | Version of the system - if relevant
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | S Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
code | S Σ | 1..1 | CodeableConcept | Code Binding: LOINCCodes (example): Codes identifying names of simple observations.
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S Σ | 1..1 | Coding | LOINC Code Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
version |  | 0..1 | string | Version of the system - if relevant
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 67162-8
subject | S Σ | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
encounter | S Σ | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
effective[x] | S Σ | 1..1 | dateTime | Zeitpunkt
value[x] | S Σ C | 1..1 | CodeableConcept | Codierter Wert
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S Σ | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
system | S Σ | 1..1 | uri | Identity of the terminology system
code | S Σ | 1..1 | code | Symbol in syntax defined by the system
note | S | 0..* | Annotation | Hinweis
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:survey | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | example | LOINC Codes | 📍4.0.1 | FHIR Std.
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG
Observation.component.​code | Base | example | LOINC 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-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()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | Observation | Measurements and simple assertions
id | S | 0..1 | id | Logical id of this artifact
meta | S | 0..1 | Meta | Metadata about the resource
profile | S | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
status | S | 1..1 | code | Status Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Required Pattern: At least the following
coding | S | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system | S | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code | S | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
code | S | 1..1 | CodeableConcept | Code
Slices for coding | S | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S | 1..1 | Coding | LOINC Code Required Pattern: At least the following
system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 67162-8
subject | S | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
reference | S | 0..1 | string | Literal reference, Relative, internal or absolute URL
encounter | S | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
reference | S | 0..1 | string | Literal reference, Relative, internal or absolute URL
effective[x] | S | 1..1 | dateTime | Zeitpunkt
value[x] | S | 1..1 | CodeableConcept | Codierter Wert
Slices for coding | S | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
system | S | 1..1 | uri | Identity of the terminology system
code | S | 1..1 | code | Symbol in syntax defined by the system
note | S | 0..* | Annotation | Hinweis
bodySite |  | 0..0 |  | Observed body part
specimen |  | 0..0 |  | Specimen used for this observation
referenceRange |  | 0..0 |  | Provides guide for interpretation
component |  | 0..0 |  | Component results
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | Observation | Measurements and simple assertions Constraints: obs-6, obs-7
id | S Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | S Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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 | Status Binding: ObservationStatus (required): Codes providing the status of an observation. Fixed Value: final
Slices for category | S | 1..* | CodeableConcept | Kategorie Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:survey | S | 1..1 | CodeableConcept | Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | S Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | S Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: survey
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
code | S Σ | 1..1 | CodeableConcept | Code Binding: LOINCCodes (example): Codes identifying names of simple observations.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:loinc | S Σ | 1..1 | Coding | LOINC Code Required Pattern: At least the following
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://loinc.org
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: 67162-8
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
subject | S Σ | 1..1 | Reference(Patient | Group) | Who and/or what the observation is about
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | S Σ | 0..1 | Reference(Encounter) | Kontakt (Aufenthaltsbezug)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
effective[x] | S Σ | 1..1 | dateTime | Zeitpunkt
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | Σ | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) | Who is responsible for the observation
value[x] | S Σ C | 1..1 | CodeableConcept | Codierter Wert
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding | S Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:Vitalstatus | S Σ | 1..1 | Coding | Vitalstatus Binding: MII VS Person Vitalstatus (required)
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
version | Σ | 0..1 | string | Version of the system - if relevant
code | S Σ | 1..1 | code | Symbol in syntax defined by the system
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
dataAbsentReason | 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 | S | 0..* | Annotation | Hinweis
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) | Related measurements the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
Observation.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
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:survey | Base | preferred | Observation Category Codes | 📍4.0.1 | FHIR Std.
Observation.code | Base | example | LOINC Codes | 📍4.0.1 | FHIR Std.
Observation.subject.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Observation.encounter.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Observation.value[x].​coding:Vitalstatus | Base | required | MII VS Person Vitalstatus | 📦2026.0.1 | This IG
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📍4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📍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 | example | LOINC Codes | 📍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-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()`

Summary

Mandatory: 13 elements
Must-Support: 25 elements
Fixed: 1 element
Prohibited: 4 elements

Slices

This structure defines the following 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

Other representations of profile: CSV, Excel, Schematron