# MII PR Person Vitalstatus - MII Implementation Guide Core Dataset Base v2026.0.1

## Resource Profile: 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](#profile) for the complete 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/resource/de.medizininformatikinitiative.kerndatensatz.base|current/StructureDefinition/StructureDefinition-mii-pr-person-vitalstatus.json)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [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",
  "meta" : {
    "extension" : [{
      "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-license",
      "valueCode" : "CC-BY-4.0"
    },
    {
      "extension" : [{
        "url" : "packageId",
        "valueId" : "de.medizininformatikinitiative.kerndatensatz.base"
      },
      {
        "url" : "version",
        "valueString" : "2026.0.1"
      },
      {
        "url" : "uri",
        "valueUri" : "https://www.medizininformatik-initiative.de/fhir/modul-base"
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/package-source"
    }],
    "profile" : ["http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablestructuredefinition",
    "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-publishablestructuredefinition"]
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
    "valueCoding" : {
      "system" : "http://hl7.org/fhir/version-algorithm",
      "code" : "semver",
      "display" : "SemVer"
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
    "valueCode" : "shareable"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
    "valueCode" : "publishable"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionPolicy",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-version-policy-codes",
        "code" : "package",
        "display" : "Package"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-usage",
    "valueMarkdown" : "Use this profile as the technical FHIR representation of the corresponding Medical Informatics Initiative logical model. The profile constrains a base FHIR resource for the MII module context by specifying how elements are used, which elements are required or not used, which extensions and terminology bindings apply, and how the resource maps to the module-specific content model. Implementers should produce and consume resource instances that conform to this profile when exchanging data for the corresponding MII module."
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/resource-approvalDate",
    "valueDate" : "2024-03-07"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/resource-effectivePeriod",
    "valuePeriod" : {
      "start" : "2026"
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-topic",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
        "code" : "C25717"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-author",
    "valueContactDetail" : {
      "telecom" : [{
        "system" : "email",
        "value" : "julian.sass@charite.de"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-editor",
    "valueContactDetail" : {
      "name" : "Taskforce Core Data Set"
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-reviewer",
    "valueContactDetail" : {
      "name" : "Interoperability Working Group",
      "telecom" : [{
        "system" : "url",
        "value" : "https://www.medizininformatik-initiative.de/en/collaboration/interoperability-working-group"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-reviewer",
    "valueContactDetail" : {
      "name" : "National Steering Committee",
      "telecom" : [{
        "system" : "url",
        "value" : "https://www.medizininformatik-initiative.de/en/collaboration/national-steering-committee"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-endorser",
    "valueContactDetail" : {
      "name" : "Interoperability Working Group",
      "telecom" : [{
        "system" : "url",
        "value" : "https://www.medizininformatik-initiative.de/en/collaboration/interoperability-working-group"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/artifact-endorser",
    "valueContactDetail" : {
      "name" : "National Steering Committee",
      "telecom" : [{
        "system" : "url",
        "value" : "https://www.medizininformatik-initiative.de/en/collaboration/national-steering-committee"
      }]
    }
  }],
  "url" : "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Vitalstatus",
  "version" : "2026.0.1",
  "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",
  "experimental" : false,
  "date" : "2026-06-09",
  "publisher" : "Medical Informatics Initiative (MII)",
  "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"
    }]
  }],
  "purpose" : "Constrain the FHIR Observation resource to represent vital status information consistently as part of the MII Person module.",
  "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" : "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.category:survey.coding",
      "path" : "Observation.category.coding",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category:survey.coding.system",
      "path" : "Observation.category.coding.system",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category:survey.coding.code",
      "path" : "Observation.category.coding.code",
      "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.subject.reference",
      "path" : "Observation.subject.reference",
      "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.encounter.reference",
      "path" : "Observation.encounter.reference",
      "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"
    }]
  }
}

```
