MII IG Laborbefund
2027.0.0-ballot - Germany

MII IG Laborbefund - Local Development build (v2027.0.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Ressourcenprofil: MII PR Labor Laboruntersuchung - Detaillierte Beschreibungen

Active Stand: 2026-09-14

Definitionen für das mii-pr-labor-laboruntersuchung ressourcenprofil

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
Definition

Measurements and simple assertions made about a patient, device or other subject.

ShortMeasurements and simple assertions
Comments

Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesVital Signs, Measurement, Results, Tests
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
obs-7: 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())
mii-lab-2: Falls kein Laborwert verfügbar ist, muss eine dataAbsentReason angegeben werden (hasMember.exists() or value.exists() or dataAbsentReason.exists())
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
obs-7: 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())
2. Observation.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control0..1
Typeidstring
Is Modifierfalse
Must Supporttrue
Summarytrue
4. Observation.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Observation.meta.source
Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.


A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

ShortIdentifies where the resource comes from
Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Observation.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.


A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles this resource claims to conform to
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control0..*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Observation.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Observation.modifierExtension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensionExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supporttrue
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Observation.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 14. Observation.modifierExtension:interpretationsbeeinflussendeEigenschaft
    Slice NameinterpretationsbeeinflussendeEigenschaft
    Definition

    Beschreibung der interpretationsbeeinflussenden interpretationsbeeinflussendeEigenschaften.

    ShortInterpretationsbeeinflussende interpretationsbeeinflussendeEigenschaft
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(MII EX Labor Interpretationsbeeinflussende Eigenschaft) (Extension Type: Coding)
    Is Modifiertrue because Diese Extension modifiziert die Bedeutung von Observation.value[x], indem sie eine Eigenschaft angibt, die die klinische Interpretation beeinflussen kann (z. B. Hämolyse, Lipämie, besondere Abnahmebedingungen). Ist die Extension vorhanden, MÜSSEN Empfängersysteme diesen Qualifizierer bei der Darstellung, Trendanalyse, dem Vergleich oder der Auslösung von Entscheidungsunterstützung berücksichtigen; ein Ignorieren kann zu Fehlinterpretationen führen.
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. Observation.identifier
    Definition

    Kennung/en, unter der/denen diese Laboruntersuchung bekannt ist.


    A unique identifier assigned to this observation.

    ShortIdentifikatorBusiness Identifier for observation
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Allows observations to be distinguished and referenced.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ type
    • 18. Observation.identifier:analyseBefundCode
      Slice NameanalyseBefundCode
      Definition

      A unique identifier assigned to this observation.

      ShortAnalyse-Befund-CodeBusiness Identifier for observation
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..1*
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Allows observations to be distinguished and referenced.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Observation.identifier:analyseBefundCode.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Observation.identifier:analyseBefundCode.type
      Definition

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control10..1
      BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
      (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/mii-vs-labor-identifier-type-codes)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "OBI"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Observation.identifier:analyseBefundCode.type.coding
      Definition

      A reference to a code defined by a terminology system.

      ShortCode defined by a terminology system
      Comments

      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control10..*
      TypeCoding
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Observation.identifier.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 26. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2
        Slice NameobservationInstanceV2
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..1*
        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.system
        Definition

        The identification of the code system that defines the meaning of the symbol in the code.

        ShortIdentity of the terminology system
        Comments

        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

        Control10..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Need to be unambiguous about the source of the definition of the symbol.

        Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0203
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.code
        Definition

        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

        ShortSymbol in syntax defined by the system
        Control10..1
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Need to refer to a particular code in the system.

        Fixed ValueOBI
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Observation.identifier:analyseBefundCode.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Identifier.system is always case sensitive.

        Control10..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        ExampleGeneral: http://www.acme.com/identifiers/patient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Observation.identifier:analyseBefundCode.value
        Definition

        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        ShortThe value that is unique
        Comments

        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control10..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        ExampleGeneral: 123456
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Observation.identifier:analyseBefundCode.assigner
        Definition

        Organization that issued/manages the identifier.

        ShortOrganization that issued id (may be just text)
        Comments

        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

        Control10..1
        TypeReference(Organization)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Observation.basedOn
        Definition

        Bezug zum Laborauftrag, auf dem diese Laboruntersuchung basiert.


        A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.

        ShortBasiert aufFulfills plan, proposal or order
        Control0..*
        TypeReference(ServiceRequest, CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ServiceRequest)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

        Alternate NamesFulfills
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Observation.status
        Definition

        abgeschlossen


        The status of the result value.

        ShortStatusregistered | preliminary | final | amended +
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

        Codes providing the status of an observation.

        Typecode
        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Need to track the status of individual results. Some results are finalized before the whole report is finalized.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Observation.category
        Definition

        Klassifikation der Laboruntersuchung im diagnostischen Fachbereich und der Laborgruppe


        A code that classifies the general type of observation being made.

        ShortKategorieClassification of type of observation
        Comments

        In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

        Control10..*
        BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
        (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

        Codes for high level observation categories.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Used for filtering what observations are retrieved and displayed.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 44. Observation.category.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. Observation.category.coding.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. Observation.category.coding.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control10..1
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. Observation.category.coding.display
          Definition

          A representation of the meaning of the code in the system, following the rules of the system.

          ShortRepresentation defined by the system
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Observation.category:observation-category
          Slice Nameobservation-category
          Definition

          Die verpflichtende Kategorie der Laboruntersuchung. Weitere Codings im selben Eintrag und weitere category-Eintraege sind zulaessig.


          A code that classifies the general type of observation being made.

          ShortLabor-KategorieClassification of type of observation
          Comments

          In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

          Control10..1*
          BindingThe codes SHOULD be taken from ObservationCategoryCodeshttp://hl7.org/fhir/ValueSet/observation-category|4.0.1
          (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

          Codes for high level observation categories.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Used for filtering what observations are retrieved and displayed.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
              "code" : "laboratory"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Observation.category:observation-category.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Observation.category:observation-category.coding.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Observation.category:observation-category.coding.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control10..1
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Observation.category:observation-category.coding.display
          Definition

          A representation of the meaning of the code in the system, following the rules of the system.

          ShortRepresentation defined by the system
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. Observation.code
          Definition

          LOINC-Code, der den gemessenen Laborparameter bzw. durchgeführten Labortest beschreibt.


          Describes what was observed. Sometimes this is called the observation "name".

          ShortCodeType of observation (code / type)
          Comments

          All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

          Control1..1
          BindingFor example codes, see LOINCCodeshttp://hl7.org/fhir/ValueSet/observation-codes|4.0.1
          (example to http://hl7.org/fhir/ValueSet/observation-codes|4.0.1)

          Codes identifying names of simple observations.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Knowing what kind of observation is being made is essential to understanding the observation.

          Alternate NamesName
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. Observation.code.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • pattern @ $this
          • 66. Observation.code.coding.system
            Definition

            The identification of the code system that defines the meaning of the symbol in the code.

            ShortIdentity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

            Control10..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Observation.code.coding.version
            Definition

            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

            ShortVersion of the system - if relevant
            Comments

            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

            NoteThis is a business version Id, not a resource version Id (see discussion)
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. Observation.code.coding.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortSymbol in syntax defined by the system
            Control10..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            72. Observation.code.coding.display
            Definition

            A representation of the meaning of the code in the system, following the rules of the system.

            ShortRepresentation defined by the system
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            74. Observation.code.coding:loinc
            Slice Nameloinc
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

            Control0..*
            BindingUnless not suitable, these codes SHALL be taken from For codes, see Results Laboratory/Pathology Observation - IPS
            (extensible to http://hl7.org/fhir/uv/ips/ValueSet/results-laboratory-pathology-observations-uv-ips)

            Intensional Value Set Definition: LOINC { { STATUS in {ACTIVE} CLASSTYPE in {1} CLASS exclude {CHALSKIN, H&P.HX.LAB, H&P.HX, NR STATS, PATH.PROTOCOLS.*} } }

            TypeCoding
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Pattern Value{
              "system" : "http://loinc.org"
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            76. Observation.code.coding:loinc.system
            Definition

            The identification of the code system that defines the meaning of the symbol in the code.

            ShortIdentity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

            Control10..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            78. Observation.code.coding:loinc.version
            Definition

            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

            ShortVersion of the system - if relevant
            Comments

            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

            NoteThis is a business version Id, not a resource version Id (see discussion)
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            80. Observation.code.coding:loinc.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortSymbol in syntax defined by the system
            Control10..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            82. Observation.code.coding:loinc.display
            Definition

            A representation of the meaning of the code in the system, following the rules of the system.

            ShortRepresentation defined by the system
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            84. Observation.subject
            Definition

            Subjekt auf welches sich die Laboruntersuchung bezieht.


            The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

            ShortSubjektWho and/or what the observation is about
            Comments

            One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

            Control10..1
            TypeReference(Patient, Group, Device, Location)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Requirements

            Observations have no value if you don't know who or what they're about.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            86. Observation.subject.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            ShortLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control0..1
            This element is affected by the following invariants: ref-1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            88. Observation.subject.identifier
            Definition

            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

            ShortLogical reference, when literal reference is not known
            Comments

            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. Observation.encounter
            Definition

            Fall oder Kontakt, in dem die Laboruntersuchung durchgeführt wurde.


            The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

            ShortFall oder KontaktHealthcare event during which this observation is made
            Comments

            This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

            Control0..1
            TypeReference(Encounter)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            For some observations it may be important to know the link between an observation and a particular encounter.

            Alternate NamesContext
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. Observation.encounter.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            ShortLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control0..1
            This element is affected by the following invariants: ref-1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. Observation.encounter.identifier
            Definition

            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

            ShortLogical reference, when literal reference is not known
            Comments

            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. Observation.effective[x]
            Definition

            Klinischer Bezugszeitpunkt der Laboruntersuchung


            The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

            ShortUntersuchungszeitpunktClinically relevant time/time-period for observation
            Comments

            At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

            Control10..1
            TypedateTime, Period, Timing, instant
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Knowing when an observation was deemed true is important to its relevance as well as determining trends.

            Alternate NamesOccurrence
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            mii-lab-1: Datetime must be at least to day (($this as dateTime).hasValue() implies ($this as dateTime).toString().length() >= 8)
            98. Observation.effective[x].extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortExtensionAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Observation.effective[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 100. Observation.effective[x].extension:QuelleKlinischesBezugsdatum
              Slice NameQuelleKlinischesBezugsdatum
              Definition

              Datum der Probenentnahme | Datum des Eingangs der Probe im Labor

              ShortQuelle klinisches Bezugsdatum
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(MII EX Labor Quelle Klinisches Bezugsdatum) (Extension Type: Coding)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              102. Observation.issued
              Definition

              Zeitpunkt, an dem das Ergebnis der Laboruntersuchung dokumentiert wurde


              The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.

              ShortDokumentationsdatumDate/Time this version was made available
              Comments

              For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

              Control0..1
              Typeinstant
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. Observation.value[x]
              Definition

              Wert der Analyse


              The information determined as a result of making the observation, if the information has a simple value.

              ShortMesswertActual result
              Comments

              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

              Control0..1
              This element is affected by the following invariants: obs-7
              TypeChoice of: Quantity, CodeableConcept, Range, Ratio, dateTime, boolean, string, SampledData, Period, integer, time
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Requirements

              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 106. Observation.value[x]:valueQuantity
                Slice NamevalueQuantity
                Definition

                The information determined as a result of making the observation, if the information has a simple value.

                ShortActual result
                Comments

                An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                Control0..1
                This element is affected by the following invariants: obs-7
                TypeQuantity, dateTime, boolean, string, SampledData, Period, Ratio, integer, time, Range, CodeableConcept
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                108. Observation.value[x]:valueQuantity.extension:pqTranslation
                Slice NamepqTranslation
                Definition

                An alternative representation of the same physical quantity expressed in a different unit from a different unit code system and possibly with a different value.

                ShortSame quantity with different units
                Comments

                It is not necessary for information processing entities to check and enforce that the translations are valid translations of the base unit, but they are allowed to do so, and to reject instances where the translations are not valid. NOTE Translations are allowed to contain other representations in UCUM units, but there is generally no point to this as it is possible to convert from one UCUM form to another.

                Control0..*
                TypeExtension(Quantity Translation) (Extension Type: Quantity)
                Is Modifierfalse
                Standard StatusDraft (from Normative)
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                110. Observation.value[x]:valueQuantity.value
                Definition

                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                ShortNumerical value (with implicit precision)
                Comments

                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                Control10..1
                Typedecimal
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                Precision is handled implicitly in almost all cases of measurement.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                112. Observation.value[x]:valueQuantity.value.extension
                Definition

                An Extension


                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortExtensionAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Observation.value[x].value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 114. Observation.value[x]:valueQuantity.value.extension:quantityPrecision
                  Slice NamequantityPrecision
                  Definition

                  Explicit precision of the number. This is the number of significant decimal places after the decimal point, irrespective of how many are actually present in the explicitly represented decimal.

                  ShortExplicit precision (number of significant decimal places)
                  Comments

                  The presence of this extension does not change conformance expectations with regard to rendering and calculations that use the number - these are still based on the raw decimal value. Applications that perform calculations SHALL ensure that this extension is removed or updated to the correct precision value if the number is changed. Applications should consider using the exponential form (e.g. 2.10e3) on the raw decimal to manage significant figures, but should be mindful of human display when doing so.

                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Precision) (Extension Type: integer)
                  Is Modifierfalse
                  Must Supporttrue
                  Standard StatusDraft (from Normative)
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  116. Observation.value[x]:valueQuantity.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  118. Observation.value[x]:valueQuantity.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control10..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  120. Observation.value[x]:valueQuantity.system
                  Definition

                  The identification of the system that provides the coded form of the unit.

                  ShortSystem that defines coded unit form
                  Control10..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to know the system that defines the coded form of the unit.

                  Fixed Valuehttp://unitsofmeasure.org
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  122. Observation.value[x]:valueQuantity.code
                  Definition

                  A computer processable form of the unit in some unit representation system.

                  ShortCoded form of the unit
                  Comments

                  The mandatory system is UCUM.


                  The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  124. Observation.value[x]:valueCodeableConcept
                  Slice NamevalueCodeableConcept
                  Definition

                  The information determined as a result of making the observation, if the information has a simple value.

                  ShortActual result
                  Comments

                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  BindingUnless not suitable, these codes SHALL be taken from For codes, see MII VS Labor Laborergebnis Codiert
                  (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Laborergebnis-codiert)
                  TypeCodeableConcept, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  126. Observation.value[x]:valueCodeableConcept.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                  Control10..*
                  TypeCoding
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  128. Observation.value[x]:valueCodeableConcept.coding.system
                  Definition

                  The identification of the code system that defines the meaning of the symbol in the code.

                  ShortIdentity of the terminology system
                  Comments

                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                  Control10..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to be unambiguous about the source of the definition of the symbol.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  130. Observation.value[x]:valueCodeableConcept.coding.version
                  Definition

                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                  ShortVersion of the system - if relevant
                  Comments

                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                  NoteThis is a business version Id, not a resource version Id (see discussion)
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  132. Observation.value[x]:valueCodeableConcept.coding.code
                  Definition

                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                  ShortSymbol in syntax defined by the system
                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  134. Observation.value[x]:valueRange
                  Slice NamevalueRange
                  Definition

                  The information determined as a result of making the observation, if the information has a simple value.

                  ShortActual result
                  Comments

                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  TypeRange, dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, CodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  136. Observation.value[x]:valueRatio
                  Slice NamevalueRatio
                  Definition

                  The information determined as a result of making the observation, if the information has a simple value.

                  ShortActual result
                  Comments

                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                  Control0..1
                  This element is affected by the following invariants: obs-7
                  TypeRatio, dateTime, boolean, string, SampledData, Quantity, Period, integer, time, Range, CodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  138. Observation.dataAbsentReason
                  Definition

                  unbekannt | maskiert | nicht anwendbar | Fehler | nicht durchgeführt


                  Provides a reason why the expected value in the element Observation.value[x] is missing.

                  ShortGrund für fehlende DatenWhy the result is missing
                  Comments

                  Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                  The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                  Control0..1
                  This element is affected by the following invariants: obs-6
                  BindingUnless not suitable, these codes SHALL be taken from DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
                  (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                  Codes specifying why the result (Observation.value[x]) is missing.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  For many results it is necessary to handle exceptional values in measurements.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  140. Observation.interpretation
                  Definition

                  Eine kategorische Bewertung des Messwertes. Zum Beispiel hoch, niedrig, normal.


                  A categorical assessment of an observation value. For example, high, low, normal.

                  ShortInterpretationHigh, low, normal, etc.
                  Comments

                  Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                  Control0..*
                  BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Interpretationhttp://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1
                  (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Interpretation)

                  Eingeschränkte Auswahl aus HL7 v3 ObservationInterpretation. FHIR bindet dieses Element extensible an das vollständige ValueSet Observation Interpretation Codes; das Modul schränkt auf die im Laborkontext sinnvollen Konzepte ein. Lokale Kodierungen wie -- - N + ++ oder L N H lassen sich darauf abbilden. Da die Bindung extensible ist, dürfen darüber hinaus weitere Codes verwendet werden; praktisch relevant sind die abnormal-Codes HH, LL und AA, etwa für Werte jenseits der Telefongrenze.


                  Codes identifying interpretations of observations.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                  Alternate NamesAbnormal Flag
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  142. Observation.note
                  Definition

                  Zusätzliche Informationen zur Laboruntersuchung als Freitext.


                  Comments about the observation or the results.

                  ShortHinweisComments about the observation
                  Comments

                  May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                  Control0..*
                  TypeAnnotation
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Need to be able to provide free text additional information.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  144. Observation.bodySite
                  Definition

                  Indicates the site on the subject's body where the observation was made (i.e. the target site).

                  ShortObserved body part
                  Comments

                  Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                  If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                  Control0..01
                  BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site|4.0.1
                  (example to http://hl7.org/fhir/ValueSet/body-site|4.0.1)

                  Codes describing anatomical locations. May include laterality.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  146. Observation.method
                  Definition

                  Konkrete Untersuchungsmethode, wenn der verwendete LOINC-Code für den Laborparameter keine Methode enthält.


                  Indicates the mechanism used to perform the observation.

                  ShortUntersuchungsmethodeHow it was done
                  Comments

                  Only used if not implicit in code for Observation.code.

                  Control0..1
                  BindingFor example codes, see ObservationMethodshttp://hl7.org/fhir/ValueSet/observation-methods|4.0.1
                  (example to http://hl7.org/fhir/ValueSet/observation-methods|4.0.1)

                  Methods for simple observations.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  148. Observation.method.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                  Control0..*
                  TypeCoding
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  150. Observation.method.coding.system
                  Definition

                  The identification of the code system that defines the meaning of the symbol in the code.

                  ShortIdentity of the terminology system
                  Comments

                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                  Control10..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to be unambiguous about the source of the definition of the symbol.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  152. Observation.method.coding.code
                  Definition

                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                  ShortSymbol in syntax defined by the system
                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  154. Observation.method.coding.display
                  Definition

                  A representation of the meaning of the code in the system, following the rules of the system.

                  ShortRepresentation defined by the system
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  156. Observation.specimen
                  Definition

                  Probe, auf deren Basis die Laboruntersuchungen angefertigt werden


                  The specimen that was used when this observation was made.

                  ShortProbenmaterialSpecimen used for this observation
                  Comments

                  Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                  Control0..1
                  TypeReference(Specimen)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  158. Observation.specimen.reference
                  Definition

                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                  ShortLiteral reference, Relative, internal or absolute URL
                  Comments

                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                  Control0..1
                  This element is affected by the following invariants: ref-1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  160. Observation.specimen.identifier
                  Definition

                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                  ShortLogical reference, when literal reference is not known
                  Comments

                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..1
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  162. Observation.device
                  Definition

                  Gerät, das zur Generierung der Messwerte verwendet wurde.


                  The device used to generate the observation data.

                  ShortGerät(Measurement) Device
                  Comments

                  Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                  Control0..1
                  TypeReference(Device, DeviceMetric)
                  Is Modifierfalse
                  Must Supporttrue
                  Must Support TypesNo must-support rules about the choice of types/profiles
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  164. Observation.device.reference
                  Definition

                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                  ShortLiteral reference, Relative, internal or absolute URL
                  Comments

                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                  Control0..1
                  This element is affected by the following invariants: ref-1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  166. Observation.device.identifier
                  Definition

                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                  ShortLogical reference, when literal reference is not known
                  Comments

                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..1
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  168. Observation.referenceRange
                  Definition

                  Bereich, in dem der Messwert als normal oder empfohlen betrachtet wird.


                  Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

                  ShortReferenzbereichProvides guide for interpretation
                  Comments

                  Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                  obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                  170. Observation.referenceRange.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  172. Observation.referenceRange.low
                  Definition

                  The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

                  ShortLow Range, if relevant
                  Control0..1
                  This element is affected by the following invariants: obs-3
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  174. Observation.referenceRange.high
                  Definition

                  The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

                  ShortHigh Range, if relevant
                  Control0..1
                  This element is affected by the following invariants: obs-3
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                  Guidance on how to interpret the contents of this table can be foundhere

                  0. Observation
                  Invariantsmii-lab-2: Falls kein Laborwert verfügbar ist, muss eine dataAbsentReason angegeben werden (hasMember.exists() or value.exists() or dataAbsentReason.exists())
                  2. Observation.id
                  Must Supporttrue
                  4. Observation.meta
                  Must Supporttrue
                  6. Observation.meta.source
                  Must Supporttrue
                  8. Observation.meta.profile
                  Must Supporttrue
                  10. Observation.modifierExtension
                  Must Supporttrue
                  SlicingThis element introduces a set of slices on Observation.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 12. Observation.modifierExtension:interpretationsbeeinflussendeEigenschaft
                    Slice NameinterpretationsbeeinflussendeEigenschaft
                    Definition

                    Beschreibung der interpretationsbeeinflussenden interpretationsbeeinflussendeEigenschaften.

                    ShortInterpretationsbeeinflussende interpretationsbeeinflussendeEigenschaft
                    Control0..*
                    TypeExtension(MII EX Labor Interpretationsbeeinflussende Eigenschaft) (Extension Type: Coding)
                    Must Supporttrue
                    14. Observation.identifier
                    Definition

                    Kennung/en, unter der/denen diese Laboruntersuchung bekannt ist.

                    ShortIdentifikator
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control1..?
                    Must Supporttrue
                    SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • pattern @ type
                    • 16. Observation.identifier:analyseBefundCode
                      Slice NameanalyseBefundCode
                      ShortAnalyse-Befund-Code
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control1..1
                      Must Supporttrue
                      18. Observation.identifier:analyseBefundCode.type
                      Control1..?
                      BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Identifier Type Codes
                      (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/mii-vs-labor-identifier-type-codes)
                      Must Supporttrue
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "OBI"
                        }]
                      }
                      20. Observation.identifier:analyseBefundCode.type.coding
                      Control1..?
                      Must Supporttrue
                      SlicingThis element introduces a set of slices on Observation.identifier.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ system
                      • 22. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2
                        Slice NameobservationInstanceV2
                        Control1..1
                        Must Supporttrue
                        24. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.system
                        Control1..?
                        Must Supporttrue
                        Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0203
                        26. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.code
                        Control1..?
                        Must Supporttrue
                        Fixed ValueOBI
                        28. Observation.identifier:analyseBefundCode.system
                        Control1..?
                        Must Supporttrue
                        30. Observation.identifier:analyseBefundCode.value
                        Control1..?
                        Must Supporttrue
                        32. Observation.identifier:analyseBefundCode.assigner
                        Control1..?
                        Must Supporttrue
                        34. Observation.basedOn
                        Definition

                        Bezug zum Laborauftrag, auf dem diese Laboruntersuchung basiert.

                        ShortBasiert auf
                        TypeReference(ServiceRequest)
                        Must Supporttrue
                        36. Observation.status
                        Definition

                        abgeschlossen

                        ShortStatus
                        Must Supporttrue
                        38. Observation.category
                        Definition

                        Klassifikation der Laboruntersuchung im diagnostischen Fachbereich und der Laborgruppe

                        ShortKategorie
                        Control1..?
                        Must Supporttrue
                        SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • pattern @ $this
                        • 40. Observation.category.coding
                          Must Supporttrue
                          42. Observation.category.coding.system
                          Control1..?
                          Must Supporttrue
                          44. Observation.category.coding.code
                          Control1..?
                          Must Supporttrue
                          46. Observation.category.coding.display
                          Must Supporttrue
                          48. Observation.category:observation-category
                          Slice Nameobservation-category
                          Definition

                          Die verpflichtende Kategorie der Laboruntersuchung. Weitere Codings im selben Eintrag und weitere category-Eintraege sind zulaessig.

                          ShortLabor-Kategorie
                          Control1..1
                          Must Supporttrue
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                              "code" : "laboratory"
                            }]
                          }
                          50. Observation.code
                          Definition

                          LOINC-Code, der den gemessenen Laborparameter bzw. durchgeführten Labortest beschreibt.

                          ShortCode
                          Must Supporttrue
                          52. Observation.code.coding
                          Must Supporttrue
                          SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • pattern @ $this
                          • 54. Observation.code.coding.system
                            Control1..?
                            Must Supporttrue
                            56. Observation.code.coding.version
                            NoteThis is a business version Id, not a resource version Id (see discussion)
                            Must Supporttrue
                            58. Observation.code.coding.code
                            Control1..?
                            Must Supporttrue
                            60. Observation.code.coding.display
                            Must Supporttrue
                            62. Observation.code.coding:loinc
                            Slice Nameloinc
                            Control0..*
                            BindingUnless not suitable, these codes SHALL be taken from Results Laboratory/Pathology Observation - IPS
                            (extensible to http://hl7.org/fhir/uv/ips/ValueSet/results-laboratory-pathology-observations-uv-ips)

                            Intensional Value Set Definition: LOINC { { STATUS in {ACTIVE} CLASSTYPE in {1} CLASS exclude {CHALSKIN, H&P.HX.LAB, H&P.HX, NR STATS, PATH.PROTOCOLS.*} } }

                            Must Supporttrue
                            Pattern Value{
                              "system" : "http://loinc.org"
                            }
                            64. Observation.subject
                            Definition

                            Subjekt auf welches sich die Laboruntersuchung bezieht.

                            ShortSubjekt
                            Control1..?
                            Must Supporttrue
                            66. Observation.subject.reference
                            Must Supporttrue
                            68. Observation.subject.identifier
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Must Supporttrue
                            70. Observation.encounter
                            Definition

                            Fall oder Kontakt, in dem die Laboruntersuchung durchgeführt wurde.

                            ShortFall oder Kontakt
                            Must Supporttrue
                            72. Observation.encounter.reference
                            Must Supporttrue
                            74. Observation.encounter.identifier
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Must Supporttrue
                            76. Observation.effective[x]
                            Definition

                            Klinischer Bezugszeitpunkt der Laboruntersuchung

                            ShortUntersuchungszeitpunkt
                            Control1..?
                            TypedateTime, Period, Timing, instant
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Invariantsmii-lab-1: Datetime must be at least to day (($this as dateTime).hasValue() implies ($this as dateTime).toString().length() >= 8)
                            78. Observation.effective[x].extension
                            SlicingThis element introduces a set of slices on Observation.effective[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 80. Observation.effective[x].extension:QuelleKlinischesBezugsdatum
                              Slice NameQuelleKlinischesBezugsdatum
                              Definition

                              Datum der Probenentnahme | Datum des Eingangs der Probe im Labor

                              ShortQuelle klinisches Bezugsdatum
                              Control0..1
                              TypeExtension(MII EX Labor Quelle Klinisches Bezugsdatum) (Extension Type: Coding)
                              Must Supporttrue
                              82. Observation.issued
                              Definition

                              Zeitpunkt, an dem das Ergebnis der Laboruntersuchung dokumentiert wurde

                              ShortDokumentationsdatum
                              Must Supporttrue
                              84. Observation.value[x]
                              Definition

                              Wert der Analyse

                              ShortMesswert
                              TypeChoice of: Quantity, CodeableConcept, Range, Ratio, dateTime, boolean, string, SampledData, Period, integer, time
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • type @ $this
                              • 86. Observation.value[x]:valueQuantity
                                Slice NamevalueQuantity
                                Control0..1
                                TypeQuantity
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Must Supporttrue
                                88. Observation.value[x]:valueQuantity.extension:pqTranslation
                                Slice NamepqTranslation
                                Control0..*
                                TypeExtension(Quantity Translation) (Extension Type: Quantity)
                                Standard StatusDraft (from Draft)
                                90. Observation.value[x]:valueQuantity.value
                                Control1..?
                                Must Supporttrue
                                92. Observation.value[x]:valueQuantity.value.extension
                                SlicingThis element introduces a set of slices on Observation.value[x].value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 94. Observation.value[x]:valueQuantity.value.extension:quantityPrecision
                                  Slice NamequantityPrecision
                                  Control0..1
                                  TypeExtension(Precision) (Extension Type: integer)
                                  Must Supporttrue
                                  Standard StatusDraft (from Draft)
                                  96. Observation.value[x]:valueQuantity.comparator
                                  Must Supporttrue
                                  98. Observation.value[x]:valueQuantity.unit
                                  Control1..?
                                  Must Supporttrue
                                  100. Observation.value[x]:valueQuantity.system
                                  Control1..?
                                  Must Supporttrue
                                  Fixed Valuehttp://unitsofmeasure.org
                                  102. Observation.value[x]:valueQuantity.code
                                  Comments

                                  The mandatory system is UCUM.

                                  Control1..?
                                  Must Supporttrue
                                  104. Observation.value[x]:valueCodeableConcept
                                  Slice NamevalueCodeableConcept
                                  Control0..1
                                  BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Laborergebnis Codiert
                                  (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Laborergebnis-codiert)
                                  TypeCodeableConcept
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Must Supporttrue
                                  106. Observation.value[x]:valueCodeableConcept.coding
                                  Control1..?
                                  Must Supporttrue
                                  108. Observation.value[x]:valueCodeableConcept.coding.system
                                  Control1..?
                                  Must Supporttrue
                                  110. Observation.value[x]:valueCodeableConcept.coding.version
                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                  Must Supporttrue
                                  112. Observation.value[x]:valueCodeableConcept.coding.code
                                  Control1..?
                                  Must Supporttrue
                                  114. Observation.value[x]:valueRange
                                  Slice NamevalueRange
                                  Control0..1
                                  TypeRange
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Must Supporttrue
                                  116. Observation.value[x]:valueRatio
                                  Slice NamevalueRatio
                                  Control0..1
                                  TypeRatio
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Must Supporttrue
                                  118. Observation.dataAbsentReason
                                  Definition

                                  unbekannt | maskiert | nicht anwendbar | Fehler | nicht durchgeführt

                                  ShortGrund für fehlende Daten
                                  Must Supporttrue
                                  120. Observation.interpretation
                                  Definition

                                  Eine kategorische Bewertung des Messwertes. Zum Beispiel hoch, niedrig, normal.

                                  ShortInterpretation
                                  BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Interpretation
                                  (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Interpretation)

                                  Eingeschränkte Auswahl aus HL7 v3 ObservationInterpretation. FHIR bindet dieses Element extensible an das vollständige ValueSet Observation Interpretation Codes; das Modul schränkt auf die im Laborkontext sinnvollen Konzepte ein. Lokale Kodierungen wie -- - N + ++ oder L N H lassen sich darauf abbilden. Da die Bindung extensible ist, dürfen darüber hinaus weitere Codes verwendet werden; praktisch relevant sind die abnormal-Codes HH, LL und AA, etwa für Werte jenseits der Telefongrenze.

                                  Must Supporttrue
                                  122. Observation.note
                                  Definition

                                  Zusätzliche Informationen zur Laboruntersuchung als Freitext.

                                  ShortHinweis
                                  Must Supporttrue
                                  124. Observation.bodySite
                                  Control0..0
                                  126. Observation.method
                                  Definition

                                  Konkrete Untersuchungsmethode, wenn der verwendete LOINC-Code für den Laborparameter keine Methode enthält.

                                  ShortUntersuchungsmethode
                                  Must Supporttrue
                                  128. Observation.method.coding
                                  Must Supporttrue
                                  130. Observation.method.coding.system
                                  Control1..?
                                  Must Supporttrue
                                  132. Observation.method.coding.code
                                  Control1..?
                                  Must Supporttrue
                                  134. Observation.method.coding.display
                                  Must Supporttrue
                                  136. Observation.specimen
                                  Definition

                                  Probe, auf deren Basis die Laboruntersuchungen angefertigt werden

                                  ShortProbenmaterial
                                  Must Supporttrue
                                  138. Observation.specimen.reference
                                  Must Supporttrue
                                  140. Observation.specimen.identifier
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Must Supporttrue
                                  142. Observation.device
                                  Definition

                                  Gerät, das zur Generierung der Messwerte verwendet wurde.

                                  ShortGerät
                                  Must Supporttrue
                                  144. Observation.device.reference
                                  Must Supporttrue
                                  146. Observation.device.identifier
                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Must Supporttrue
                                  148. Observation.referenceRange
                                  Definition

                                  Bereich, in dem der Messwert als normal oder empfohlen betrachtet wird.

                                  ShortReferenzbereich
                                  Must Supporttrue
                                  150. Observation.referenceRange.low
                                  Must Supporttrue
                                  152. Observation.referenceRange.high
                                  Must Supporttrue

                                  Guidance on how to interpret the contents of this table can be foundhere

                                  0. Observation
                                  Definition

                                  Measurements and simple assertions made about a patient, device or other subject.

                                  ShortMeasurements and simple assertions
                                  Comments

                                  Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

                                  Control0..*
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate NamesVital Signs, Measurement, Results, Tests
                                  Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                  dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                  dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                  obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
                                  obs-7: 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())
                                  mii-lab-2: Falls kein Laborwert verfügbar ist, muss eine dataAbsentReason angegeben werden (hasMember.exists() or value.exists() or dataAbsentReason.exists())
                                  2. Observation.id
                                  Definition

                                  The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                                  ShortLogical id of this artifact
                                  Comments

                                  The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                                  Control0..1
                                  Typeid
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  4. Observation.meta
                                  Definition

                                  The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                                  ShortMetadata about the resource
                                  Control0..1
                                  TypeMeta
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  6. Observation.meta.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  8. Observation.meta.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on Observation.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 10. Observation.meta.versionId
                                    Definition

                                    The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                                    ShortVersion specific identifier
                                    Comments

                                    The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                                    Control0..1
                                    Typeid
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    12. Observation.meta.lastUpdated
                                    Definition

                                    When the resource last changed - e.g. when the version changed.

                                    ShortWhen the resource version last changed
                                    Comments

                                    This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                                    Control0..1
                                    Typeinstant
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    14. Observation.meta.source
                                    Definition

                                    A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                                    ShortIdentifies where the resource comes from
                                    Comments

                                    In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                                    This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                                    Control0..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    16. Observation.meta.profile
                                    Definition

                                    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                                    ShortProfiles this resource claims to conform to
                                    Comments

                                    It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                                    Control0..*
                                    Typecanonical(StructureDefinition)
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    18. Observation.meta.security
                                    Definition

                                    Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                                    ShortSecurity Labels applied to this resource
                                    Comments

                                    The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                                    Control0..*
                                    BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                    (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

                                    Security Labels from the Healthcare Privacy and Security Classification System.

                                    TypeCoding
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    20. Observation.meta.tag
                                    Definition

                                    Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                                    ShortTags applied to this resource
                                    Comments

                                    The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                                    Control0..*
                                    BindingFor example codes, see CommonTags
                                    (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

                                    Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                                    TypeCoding
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    22. Observation.implicitRules
                                    Definition

                                    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                    ShortA set of rules under which this content was created
                                    Comments

                                    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                    Control0..1
                                    Typeuri
                                    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    24. Observation.language
                                    Definition

                                    The base language in which the resource is written.

                                    ShortLanguage of the resource content
                                    Comments

                                    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                                    Control0..1
                                    BindingThe codes SHOULD be taken from CommonLanguages
                                    (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                                    A human language.

                                    Additional BindingsPurpose
                                    AllLanguagesMax Binding
                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    26. Observation.text
                                    Definition

                                    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                                    ShortText summary of the resource, for human interpretation
                                    Comments

                                    Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                                    Control0..1
                                    TypeNarrative
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesnarrative, html, xhtml, display
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    28. Observation.contained
                                    Definition

                                    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                                    ShortContained, inline Resources
                                    Comments

                                    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                                    Control0..*
                                    TypeResource
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesinline resources, anonymous resources, contained resources
                                    30. Observation.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    32. Observation.modifierExtension
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    SlicingThis element introduces a set of slices on Observation.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 34. Observation.modifierExtension:interpretationsbeeinflussendeEigenschaft
                                      Slice NameinterpretationsbeeinflussendeEigenschaft
                                      Definition

                                      Beschreibung der interpretationsbeeinflussenden interpretationsbeeinflussendeEigenschaften.

                                      ShortInterpretationsbeeinflussende interpretationsbeeinflussendeEigenschaft
                                      Control0..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(MII EX Labor Interpretationsbeeinflussende Eigenschaft) (Extension Type: Coding)
                                      Is Modifiertrue because Diese Extension modifiziert die Bedeutung von Observation.value[x], indem sie eine Eigenschaft angibt, die die klinische Interpretation beeinflussen kann (z. B. Hämolyse, Lipämie, besondere Abnahmebedingungen). Ist die Extension vorhanden, MÜSSEN Empfängersysteme diesen Qualifizierer bei der Darstellung, Trendanalyse, dem Vergleich oder der Auslösung von Entscheidungsunterstützung berücksichtigen; ein Ignorieren kann zu Fehlinterpretationen führen.
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      36. Observation.identifier
                                      Definition

                                      Kennung/en, unter der/denen diese Laboruntersuchung bekannt ist.

                                      ShortIdentifikator
                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                      Control1..*
                                      TypeIdentifier
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements

                                      Allows observations to be distinguished and referenced.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on Observation.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • pattern @ type
                                      • 38. Observation.identifier:analyseBefundCode
                                        Slice NameanalyseBefundCode
                                        Definition

                                        A unique identifier assigned to this observation.

                                        ShortAnalyse-Befund-Code
                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                        Control1..1
                                        TypeIdentifier
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

                                        Allows observations to be distinguished and referenced.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        40. Observation.identifier:analyseBefundCode.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        42. Observation.identifier:analyseBefundCode.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on Observation.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 44. Observation.identifier:analyseBefundCode.use
                                          Definition

                                          The purpose of this identifier.

                                          Shortusual | official | temp | secondary | old (If known)
                                          Comments

                                          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                          Control0..1
                                          BindingThe codes SHALL be taken from IdentifierUse
                                          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                          Identifies the purpose for this identifier, if known .

                                          Typecode
                                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          46. Observation.identifier:analyseBefundCode.type
                                          Definition

                                          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                          ShortDescription of identifier
                                          Comments

                                          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Identifier Type Codes
                                          (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/mii-vs-labor-identifier-type-codes)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Allows users to make use of identifiers when the identifier system is not known.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                              "code" : "OBI"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          48. Observation.identifier:analyseBefundCode.type.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          50. Observation.identifier:analyseBefundCode.type.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          SlicingThis element introduces a set of slices on Observation.identifier.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 52. Observation.identifier:analyseBefundCode.type.coding
                                            Definition

                                            A reference to a code defined by a terminology system.

                                            ShortCode defined by a terminology system
                                            Comments

                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                            Control1..*
                                            TypeCoding
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on Observation.identifier.type.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ system
                                            • 54. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2
                                              Slice NameobservationInstanceV2
                                              Definition

                                              A reference to a code defined by a terminology system.

                                              ShortCode defined by a terminology system
                                              Comments

                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                              Control1..1
                                              TypeCoding
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              56. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              58. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              SlicingThis element introduces a set of slices on Observation.identifier.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 60. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.system
                                                Definition

                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                ShortIdentity of the terminology system
                                                Comments

                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to be unambiguous about the source of the definition of the symbol.

                                                Fixed Valuehttp://terminology.hl7.org/CodeSystem/v2-0203
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                62. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.version
                                                Definition

                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                ShortVersion of the system - if relevant
                                                Comments

                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                64. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.code
                                                Definition

                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                ShortSymbol in syntax defined by the system
                                                Control1..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to refer to a particular code in the system.

                                                Fixed ValueOBI
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                66. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.display
                                                Definition

                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                ShortRepresentation defined by the system
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                68. Observation.identifier:analyseBefundCode.type.coding:observationInstanceV2.userSelected
                                                Definition

                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                ShortIf this coding was chosen directly by the user
                                                Comments

                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                Control0..1
                                                Typeboolean
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                70. Observation.identifier:analyseBefundCode.type.text
                                                Definition

                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortPlain text representation of the concept
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                72. Observation.identifier:analyseBefundCode.system
                                                Definition

                                                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                ShortThe namespace for the identifier value
                                                Comments

                                                Identifier.system is always case sensitive.

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                ExampleGeneral: http://www.acme.com/identifiers/patient
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                74. Observation.identifier:analyseBefundCode.value
                                                Definition

                                                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                ShortThe value that is unique
                                                Comments

                                                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                Control1..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                ExampleGeneral: 123456
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                76. Observation.identifier:analyseBefundCode.period
                                                Definition

                                                Time period during which identifier is/was valid for use.

                                                ShortTime period when id is/was valid for use
                                                Control0..1
                                                TypePeriod
                                                Is Modifierfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                78. Observation.identifier:analyseBefundCode.assigner
                                                Definition

                                                Organization that issued/manages the identifier.

                                                ShortOrganization that issued id (may be just text)
                                                Comments

                                                The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                Control1..1
                                                TypeReference(Organization)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                80. Observation.basedOn
                                                Definition

                                                Bezug zum Laborauftrag, auf dem diese Laboruntersuchung basiert.

                                                ShortBasiert auf
                                                Control0..*
                                                TypeReference(ServiceRequest)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                                                Alternate NamesFulfills
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                82. Observation.partOf
                                                Definition

                                                A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.

                                                ShortPart of referenced event
                                                Comments

                                                To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

                                                Control0..*
                                                TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Immunization, ImagingStudy)
                                                Is Modifierfalse
                                                Summarytrue
                                                Alternate NamesContainer
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                84. Observation.status
                                                Definition

                                                abgeschlossen

                                                ShortStatus
                                                Comments

                                                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                                Control1..1
                                                BindingThe codes SHALL be taken from ObservationStatus
                                                (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

                                                Codes providing the status of an observation.

                                                Typecode
                                                Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Need to track the status of individual results. Some results are finalized before the whole report is finalized.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                86. Observation.category
                                                Definition

                                                Klassifikation der Laboruntersuchung im diagnostischen Fachbereich und der Laborgruppe

                                                ShortKategorie
                                                Comments

                                                In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                Control1..*
                                                BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                Codes for high level observation categories.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                Used for filtering what observations are retrieved and displayed.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • pattern @ $this
                                                • 88. Observation.category.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  90. Observation.category.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 92. Observation.category.coding
                                                    Definition

                                                    A reference to a code defined by a terminology system.

                                                    ShortCode defined by a terminology system
                                                    Comments

                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                    Control0..*
                                                    TypeCoding
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    94. Observation.category.coding.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    96. Observation.category.coding.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 98. Observation.category.coding.system
                                                      Definition

                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                      ShortIdentity of the terminology system
                                                      Comments

                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                      Control1..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      100. Observation.category.coding.version
                                                      Definition

                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                      ShortVersion of the system - if relevant
                                                      Comments

                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      102. Observation.category.coding.code
                                                      Definition

                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                      ShortSymbol in syntax defined by the system
                                                      Control1..1
                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to refer to a particular code in the system.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      104. Observation.category.coding.display
                                                      Definition

                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                      ShortRepresentation defined by the system
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      106. Observation.category.coding.userSelected
                                                      Definition

                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                      ShortIf this coding was chosen directly by the user
                                                      Comments

                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                      Control0..1
                                                      Typeboolean
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      108. Observation.category.text
                                                      Definition

                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                      ShortPlain text representation of the concept
                                                      Comments

                                                      Very often the text is the same as a displayName of one of the codings.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      110. Observation.category:observation-category
                                                      Slice Nameobservation-category
                                                      Definition

                                                      Die verpflichtende Kategorie der Laboruntersuchung. Weitere Codings im selben Eintrag und weitere category-Eintraege sind zulaessig.

                                                      ShortLabor-Kategorie
                                                      Comments

                                                      In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

                                                      Control1..1
                                                      BindingThe codes SHOULD be taken from ObservationCategoryCodes
                                                      (preferred to http://hl7.org/fhir/ValueSet/observation-category|4.0.1)

                                                      Codes for high level observation categories.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      Used for filtering what observations are retrieved and displayed.

                                                      Pattern Value{
                                                        "coding" : [{
                                                          "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
                                                          "code" : "laboratory"
                                                        }]
                                                      }
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      112. Observation.category:observation-category.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      114. Observation.category:observation-category.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Observation.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 116. Observation.category:observation-category.coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

                                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                        Control0..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        118. Observation.category:observation-category.coding.id
                                                        Definition

                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        120. Observation.category:observation-category.coding.extension
                                                        Definition

                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                        ShortAdditional content defined by implementations
                                                        Comments

                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Alternate Namesextensions, user content
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                        SlicingThis element introduces a set of slices on Observation.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 122. Observation.category:observation-category.coding.system
                                                          Definition

                                                          The identification of the code system that defines the meaning of the symbol in the code.

                                                          ShortIdentity of the terminology system
                                                          Comments

                                                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                          Control1..1
                                                          Typeuri
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Need to be unambiguous about the source of the definition of the symbol.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          124. Observation.category:observation-category.coding.version
                                                          Definition

                                                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                          ShortVersion of the system - if relevant
                                                          Comments

                                                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          126. Observation.category:observation-category.coding.code
                                                          Definition

                                                          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                          ShortSymbol in syntax defined by the system
                                                          Control1..1
                                                          Typecode
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Need to refer to a particular code in the system.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          128. Observation.category:observation-category.coding.display
                                                          Definition

                                                          A representation of the meaning of the code in the system, following the rules of the system.

                                                          ShortRepresentation defined by the system
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          130. Observation.category:observation-category.coding.userSelected
                                                          Definition

                                                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                          ShortIf this coding was chosen directly by the user
                                                          Comments

                                                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                          Control0..1
                                                          Typeboolean
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          132. Observation.category:observation-category.text
                                                          Definition

                                                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                          ShortPlain text representation of the concept
                                                          Comments

                                                          Very often the text is the same as a displayName of one of the codings.

                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          134. Observation.code
                                                          Definition

                                                          LOINC-Code, der den gemessenen Laborparameter bzw. durchgeführten Labortest beschreibt.

                                                          ShortCode
                                                          Comments

                                                          All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                          Control1..1
                                                          BindingFor example codes, see LOINCCodes
                                                          (example to http://hl7.org/fhir/ValueSet/observation-codes|4.0.1)

                                                          Codes identifying names of simple observations.

                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Knowing what kind of observation is being made is essential to understanding the observation.

                                                          Alternate NamesName
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          136. Observation.code.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          138. Observation.code.extension
                                                          Definition

                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          SlicingThis element introduces a set of slices on Observation.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 140. Observation.code.coding
                                                            Definition

                                                            A reference to a code defined by a terminology system.

                                                            ShortCode defined by a terminology system
                                                            Comments

                                                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                            Control0..*
                                                            TypeCoding
                                                            Is Modifierfalse
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            SlicingThis element introduces a set of slices on Observation.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • pattern @ $this
                                                            • 142. Observation.code.coding.id
                                                              Definition

                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              144. Observation.code.coding.extension
                                                              Definition

                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                              ShortAdditional content defined by implementations
                                                              Comments

                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 146. Observation.code.coding.system
                                                                Definition

                                                                The identification of the code system that defines the meaning of the symbol in the code.

                                                                ShortIdentity of the terminology system
                                                                Comments

                                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                Control1..1
                                                                Typeuri
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Requirements

                                                                Need to be unambiguous about the source of the definition of the symbol.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                148. Observation.code.coding.version
                                                                Definition

                                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                ShortVersion of the system - if relevant
                                                                Comments

                                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                150. Observation.code.coding.code
                                                                Definition

                                                                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                ShortSymbol in syntax defined by the system
                                                                Control1..1
                                                                Typecode
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Requirements

                                                                Need to refer to a particular code in the system.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                152. Observation.code.coding.display
                                                                Definition

                                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                                ShortRepresentation defined by the system
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Requirements

                                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                154. Observation.code.coding.userSelected
                                                                Definition

                                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                ShortIf this coding was chosen directly by the user
                                                                Comments

                                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                Control0..1
                                                                Typeboolean
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Requirements

                                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                156. Observation.code.coding:loinc
                                                                Slice Nameloinc
                                                                Definition

                                                                A reference to a code defined by a terminology system.

                                                                ShortCode defined by a terminology system
                                                                Comments

                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                Control0..*
                                                                BindingUnless not suitable, these codes SHALL be taken from Results Laboratory/Pathology Observation - IPS
                                                                (extensible to http://hl7.org/fhir/uv/ips/ValueSet/results-laboratory-pathology-observations-uv-ips)

                                                                Intensional Value Set Definition: LOINC { { STATUS in {ACTIVE} CLASSTYPE in {1} CLASS exclude {CHALSKIN, H&P.HX.LAB, H&P.HX, NR STATS, PATH.PROTOCOLS.*} } }

                                                                TypeCoding
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Requirements

                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                Pattern Value{
                                                                  "system" : "http://loinc.org"
                                                                }
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                158. Observation.code.coding:loinc.id
                                                                Definition

                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                160. Observation.code.coding:loinc.extension
                                                                Definition

                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                ShortAdditional content defined by implementations
                                                                Comments

                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                SlicingThis element introduces a set of slices on Observation.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 162. Observation.code.coding:loinc.system
                                                                  Definition

                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                  ShortIdentity of the terminology system
                                                                  Comments

                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                  Control1..1
                                                                  Typeuri
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  164. Observation.code.coding:loinc.version
                                                                  Definition

                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                  ShortVersion of the system - if relevant
                                                                  Comments

                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  166. Observation.code.coding:loinc.code
                                                                  Definition

                                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                  ShortSymbol in syntax defined by the system
                                                                  Control1..1
                                                                  Typecode
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to refer to a particular code in the system.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  168. Observation.code.coding:loinc.display
                                                                  Definition

                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                  ShortRepresentation defined by the system
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  170. Observation.code.coding:loinc.userSelected
                                                                  Definition

                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                  ShortIf this coding was chosen directly by the user
                                                                  Comments

                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                  Control0..1
                                                                  Typeboolean
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  172. Observation.code.text
                                                                  Definition

                                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                  ShortPlain text representation of the concept
                                                                  Comments

                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  174. Observation.subject
                                                                  Definition

                                                                  Subjekt auf welches sich die Laboruntersuchung bezieht.

                                                                  ShortSubjekt
                                                                  Comments

                                                                  One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

                                                                  Control1..1
                                                                  TypeReference(Patient, Group, Device, Location)
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Must Support TypesNo must-support rules about the choice of types/profiles
                                                                  Summarytrue
                                                                  Requirements

                                                                  Observations have no value if you don't know who or what they're about.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  176. Observation.subject.id
                                                                  Definition

                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  ShortUnique id for inter-element referencing
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  178. Observation.subject.extension
                                                                  Definition

                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                  ShortAdditional content defined by implementations
                                                                  Comments

                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                  Control0..*
                                                                  TypeExtension
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Alternate Namesextensions, user content
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  SlicingThis element introduces a set of slices on Observation.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 180. Observation.subject.reference
                                                                    Definition

                                                                    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                    ShortLiteral reference, Relative, internal or absolute URL
                                                                    Comments

                                                                    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                    Control0..1
                                                                    This element is affected by the following invariants: ref-1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    182. Observation.subject.type
                                                                    Definition

                                                                    The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                    The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                    ShortType the reference refers to (e.g. "Patient")
                                                                    Comments

                                                                    This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                    Control0..1
                                                                    BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                    (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                    Aa resource (or, for logical models, the URI of the logical model).

                                                                    Typeuri
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    184. Observation.subject.identifier
                                                                    Definition

                                                                    An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                    ShortLogical reference, when literal reference is not known
                                                                    Comments

                                                                    When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                    Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                    Control0..1
                                                                    TypeIdentifier
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    186. Observation.subject.display
                                                                    Definition

                                                                    Plain text narrative that identifies the resource in addition to the resource reference.

                                                                    ShortText alternative for the resource
                                                                    Comments

                                                                    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    188. Observation.focus
                                                                    Definition

                                                                    The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

                                                                    ShortWhat the observation is about, when it is not about the subject of record
                                                                    Comments

                                                                    Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

                                                                    Control0..*
                                                                    TypeReference(Resource)
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    190. Observation.encounter
                                                                    Definition

                                                                    Fall oder Kontakt, in dem die Laboruntersuchung durchgeführt wurde.

                                                                    ShortFall oder Kontakt
                                                                    Comments

                                                                    This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

                                                                    Control0..1
                                                                    TypeReference(Encounter)
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Requirements

                                                                    For some observations it may be important to know the link between an observation and a particular encounter.

                                                                    Alternate NamesContext
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    192. Observation.encounter.id
                                                                    Definition

                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    194. Observation.encounter.extension
                                                                    Definition

                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                    ShortAdditional content defined by implementations
                                                                    Comments

                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate Namesextensions, user content
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    SlicingThis element introduces a set of slices on Observation.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 196. Observation.encounter.reference
                                                                      Definition

                                                                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                                      Comments

                                                                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                      Control0..1
                                                                      This element is affected by the following invariants: ref-1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      198. Observation.encounter.type
                                                                      Definition

                                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                      ShortType the reference refers to (e.g. "Patient")
                                                                      Comments

                                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                      Control0..1
                                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                      Aa resource (or, for logical models, the URI of the logical model).

                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      200. Observation.encounter.identifier
                                                                      Definition

                                                                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                      ShortLogical reference, when literal reference is not known
                                                                      Comments

                                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                      Control0..1
                                                                      TypeIdentifier
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      202. Observation.encounter.display
                                                                      Definition

                                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                                      ShortText alternative for the resource
                                                                      Comments

                                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      204. Observation.effective[x]
                                                                      Definition

                                                                      Klinischer Bezugszeitpunkt der Laboruntersuchung

                                                                      ShortUntersuchungszeitpunkt
                                                                      Comments

                                                                      At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

                                                                      Control1..1
                                                                      TypedateTime
                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

                                                                      Knowing when an observation was deemed true is important to its relevance as well as determining trends.

                                                                      Alternate NamesOccurrence
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      mii-lab-1: Datetime must be at least to day (($this as dateTime).hasValue() implies ($this as dateTime).toString().length() >= 8)
                                                                      206. Observation.effective[x].id
                                                                      Definition

                                                                      unique id for the element within a resource (for internal references)

                                                                      Shortxml:id (or equivalent in JSON)
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      208. Observation.effective[x].extension
                                                                      Definition

                                                                      An Extension

                                                                      ShortExtension
                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      SlicingThis element introduces a set of slices on Observation.effective[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 210. Observation.effective[x].extension:QuelleKlinischesBezugsdatum
                                                                        Slice NameQuelleKlinischesBezugsdatum
                                                                        Definition

                                                                        Datum der Probenentnahme | Datum des Eingangs der Probe im Labor

                                                                        ShortQuelle klinisches Bezugsdatum
                                                                        Control0..1
                                                                        This element is affected by the following invariants: ele-1
                                                                        TypeExtension(MII EX Labor Quelle Klinisches Bezugsdatum) (Extension Type: Coding)
                                                                        Is Modifierfalse
                                                                        Must Supporttrue
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        212. Observation.effective[x].value
                                                                        Definition

                                                                        The actual value

                                                                        ShortPrimitive value for dateTime
                                                                        Control0..1
                                                                        TypedateTime
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        214. Observation.issued
                                                                        Definition

                                                                        Zeitpunkt, an dem das Ergebnis der Laboruntersuchung dokumentiert wurde

                                                                        ShortDokumentationsdatum
                                                                        Comments

                                                                        For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

                                                                        Control0..1
                                                                        Typeinstant
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        216. Observation.performer
                                                                        Definition

                                                                        Who was responsible for asserting the observed value as "true".

                                                                        ShortWho is responsible for the observation
                                                                        Control0..*
                                                                        TypeReference(Practitioner, PractitionerRole, Organization, CareTeam, Patient, RelatedPerson)
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        218. Observation.value[x]
                                                                        Definition

                                                                        Wert der Analyse

                                                                        ShortMesswert
                                                                        Comments

                                                                        An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                        Control0..1
                                                                        This element is affected by the following invariants: obs-7
                                                                        TypeChoice of: Quantity, CodeableConcept, Range, Ratio
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Is Modifierfalse
                                                                        Must Supporttrue
                                                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                                                        Summarytrue
                                                                        Requirements

                                                                        An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        SlicingThis element introduces a set of slices on Observation.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                        • type @ $this
                                                                        • 220. Observation.value[x]:valueQuantity
                                                                          Slice NamevalueQuantity
                                                                          Definition

                                                                          The information determined as a result of making the observation, if the information has a simple value.

                                                                          ShortActual result
                                                                          Comments

                                                                          An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                          Control0..1
                                                                          This element is affected by the following invariants: obs-7
                                                                          TypeQuantity
                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summarytrue
                                                                          Requirements

                                                                          An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          222. Observation.value[x]:valueQuantity.id
                                                                          Definition

                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          224. Observation.value[x]:valueQuantity.extension
                                                                          Definition

                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 226. Observation.value[x]:valueQuantity.extension:pqTranslation
                                                                            Slice NamepqTranslation
                                                                            Definition

                                                                            An alternative representation of the same physical quantity expressed in a different unit from a different unit code system and possibly with a different value.

                                                                            ShortSame quantity with different units
                                                                            Comments

                                                                            It is not necessary for information processing entities to check and enforce that the translations are valid translations of the base unit, but they are allowed to do so, and to reject instances where the translations are not valid. NOTE Translations are allowed to contain other representations in UCUM units, but there is generally no point to this as it is possible to convert from one UCUM form to another.

                                                                            Control0..*
                                                                            TypeExtension(Quantity Translation) (Extension Type: Quantity)
                                                                            Is Modifierfalse
                                                                            Standard StatusDraft (from Normative)
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            228. Observation.value[x]:valueQuantity.value
                                                                            Definition

                                                                            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                                            ShortNumerical value (with implicit precision)
                                                                            Comments

                                                                            The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                                            Control1..1
                                                                            Typedecimal
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Must Supporttrue
                                                                            Summarytrue
                                                                            Requirements

                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            230. Observation.value[x]:valueQuantity.value.id
                                                                            Definition

                                                                            unique id for the element within a resource (for internal references)

                                                                            Shortxml:id (or equivalent in JSON)
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            232. Observation.value[x]:valueQuantity.value.extension
                                                                            Definition

                                                                            An Extension

                                                                            ShortExtension
                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            SlicingThis element introduces a set of slices on Observation.value[x].value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 234. Observation.value[x]:valueQuantity.value.extension:quantityPrecision
                                                                              Slice NamequantityPrecision
                                                                              Definition

                                                                              Explicit precision of the number. This is the number of significant decimal places after the decimal point, irrespective of how many are actually present in the explicitly represented decimal.

                                                                              ShortExplicit precision (number of significant decimal places)
                                                                              Comments

                                                                              The presence of this extension does not change conformance expectations with regard to rendering and calculations that use the number - these are still based on the raw decimal value. Applications that perform calculations SHALL ensure that this extension is removed or updated to the correct precision value if the number is changed. Applications should consider using the exponential form (e.g. 2.10e3) on the raw decimal to manage significant figures, but should be mindful of human display when doing so.

                                                                              Control0..1
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(Precision) (Extension Type: integer)
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Standard StatusDraft (from Normative)
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              236. Observation.value[x]:valueQuantity.value.value
                                                                              Definition

                                                                              The actual value

                                                                              ShortPrimitive value for decimal
                                                                              Control0..1
                                                                              Typedecimal
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              238. Observation.value[x]:valueQuantity.comparator
                                                                              Definition

                                                                              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                                              Short< | <= | >= | > - how to understand the value
                                                                              Control0..1
                                                                              BindingThe codes SHALL be taken from QuantityComparator
                                                                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                              How the Quantity should be understood and represented.

                                                                              Typecode
                                                                              Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                                              Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              240. Observation.value[x]:valueQuantity.unit
                                                                              Definition

                                                                              A human-readable form of the unit.

                                                                              ShortUnit representation
                                                                              Control1..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              242. Observation.value[x]:valueQuantity.system
                                                                              Definition

                                                                              The identification of the system that provides the coded form of the unit.

                                                                              ShortSystem that defines coded unit form
                                                                              Control1..1
                                                                              This element is affected by the following invariants: qty-3
                                                                              Typeuri
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need to know the system that defines the coded form of the unit.

                                                                              Fixed Valuehttp://unitsofmeasure.org
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              244. Observation.value[x]:valueQuantity.code
                                                                              Definition

                                                                              A computer processable form of the unit in some unit representation system.

                                                                              ShortCoded form of the unit
                                                                              Comments

                                                                              The mandatory system is UCUM.

                                                                              Control1..1
                                                                              Typecode
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              246. Observation.value[x]:valueCodeableConcept
                                                                              Slice NamevalueCodeableConcept
                                                                              Definition

                                                                              The information determined as a result of making the observation, if the information has a simple value.

                                                                              ShortActual result
                                                                              Comments

                                                                              An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                              Control0..1
                                                                              This element is affected by the following invariants: obs-7
                                                                              BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Laborergebnis Codiert
                                                                              (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Laborergebnis-codiert)
                                                                              TypeCodeableConcept
                                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              248. Observation.value[x]:valueCodeableConcept.id
                                                                              Definition

                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                              ShortUnique id for inter-element referencing
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              250. Observation.value[x]:valueCodeableConcept.extension
                                                                              Definition

                                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                              ShortAdditional content defined by implementations
                                                                              Comments

                                                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                              Control0..*
                                                                              TypeExtension
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Alternate Namesextensions, user content
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              SlicingThis element introduces a set of slices on Observation.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 252. Observation.value[x]:valueCodeableConcept.coding
                                                                                Definition

                                                                                A reference to a code defined by a terminology system.

                                                                                ShortCode defined by a terminology system
                                                                                Comments

                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                Control1..*
                                                                                TypeCoding
                                                                                Is Modifierfalse
                                                                                Must Supporttrue
                                                                                Summarytrue
                                                                                Requirements

                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                254. Observation.value[x]:valueCodeableConcept.coding.id
                                                                                Definition

                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                ShortUnique id for inter-element referencing
                                                                                Control0..1
                                                                                Typestring
                                                                                Is Modifierfalse
                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                Summaryfalse
                                                                                256. Observation.value[x]:valueCodeableConcept.coding.extension
                                                                                Definition

                                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                ShortAdditional content defined by implementations
                                                                                Comments

                                                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                Control0..*
                                                                                TypeExtension
                                                                                Is Modifierfalse
                                                                                Summaryfalse
                                                                                Alternate Namesextensions, user content
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                SlicingThis element introduces a set of slices on Observation.value[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 258. Observation.value[x]:valueCodeableConcept.coding.system
                                                                                  Definition

                                                                                  The identification of the code system that defines the meaning of the symbol in the code.

                                                                                  ShortIdentity of the terminology system
                                                                                  Comments

                                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                  Control1..1
                                                                                  Typeuri
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  260. Observation.value[x]:valueCodeableConcept.coding.version
                                                                                  Definition

                                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                  ShortVersion of the system - if relevant
                                                                                  Comments

                                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  262. Observation.value[x]:valueCodeableConcept.coding.code
                                                                                  Definition

                                                                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                  ShortSymbol in syntax defined by the system
                                                                                  Control1..1
                                                                                  Typecode
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Need to refer to a particular code in the system.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  264. Observation.value[x]:valueCodeableConcept.coding.display
                                                                                  Definition

                                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                                  ShortRepresentation defined by the system
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  266. Observation.value[x]:valueCodeableConcept.coding.userSelected
                                                                                  Definition

                                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                  ShortIf this coding was chosen directly by the user
                                                                                  Comments

                                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                  Control0..1
                                                                                  Typeboolean
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  268. Observation.value[x]:valueCodeableConcept.text
                                                                                  Definition

                                                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                  ShortPlain text representation of the concept
                                                                                  Comments

                                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  270. Observation.value[x]:valueRange
                                                                                  Slice NamevalueRange
                                                                                  Definition

                                                                                  The information determined as a result of making the observation, if the information has a simple value.

                                                                                  ShortActual result
                                                                                  Comments

                                                                                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                  Control0..1
                                                                                  This element is affected by the following invariants: obs-7
                                                                                  TypeRange
                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  272. Observation.value[x]:valueRatio
                                                                                  Slice NamevalueRatio
                                                                                  Definition

                                                                                  The information determined as a result of making the observation, if the information has a simple value.

                                                                                  ShortActual result
                                                                                  Comments

                                                                                  An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                  Control0..1
                                                                                  This element is affected by the following invariants: obs-7
                                                                                  TypeRatio
                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  274. Observation.dataAbsentReason
                                                                                  Definition

                                                                                  unbekannt | maskiert | nicht anwendbar | Fehler | nicht durchgeführt

                                                                                  ShortGrund für fehlende Daten
                                                                                  Comments

                                                                                  Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

                                                                                  The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

                                                                                  Control0..1
                                                                                  This element is affected by the following invariants: obs-6
                                                                                  BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                                                                                  Codes specifying why the result (Observation.value[x]) is missing.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  For many results it is necessary to handle exceptional values in measurements.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  276. Observation.interpretation
                                                                                  Definition

                                                                                  Eine kategorische Bewertung des Messwertes. Zum Beispiel hoch, niedrig, normal.

                                                                                  ShortInterpretation
                                                                                  Comments

                                                                                  Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                  Control0..*
                                                                                  BindingUnless not suitable, these codes SHALL be taken from MII VS Labor Interpretation
                                                                                  (extensible to https://www.medizininformatik-initiative.de/fhir/core/modul-labor/ValueSet/Interpretation)

                                                                                  Eingeschränkte Auswahl aus HL7 v3 ObservationInterpretation. FHIR bindet dieses Element extensible an das vollständige ValueSet Observation Interpretation Codes; das Modul schränkt auf die im Laborkontext sinnvollen Konzepte ein. Lokale Kodierungen wie -- - N + ++ oder L N H lassen sich darauf abbilden. Da die Bindung extensible ist, dürfen darüber hinaus weitere Codes verwendet werden; praktisch relevant sind die abnormal-Codes HH, LL und AA, etwa für Werte jenseits der Telefongrenze.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                  Alternate NamesAbnormal Flag
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  278. Observation.note
                                                                                  Definition

                                                                                  Zusätzliche Informationen zur Laboruntersuchung als Freitext.

                                                                                  ShortHinweis
                                                                                  Comments

                                                                                  May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

                                                                                  Control0..*
                                                                                  TypeAnnotation
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Need to be able to provide free text additional information.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  280. Observation.bodySite
                                                                                  Definition

                                                                                  Indicates the site on the subject's body where the observation was made (i.e. the target site).

                                                                                  ShortObserved body part
                                                                                  Comments

                                                                                  Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

                                                                                  If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

                                                                                  Control0..0
                                                                                  BindingFor example codes, see SNOMEDCTBodyStructures
                                                                                  (example to http://hl7.org/fhir/ValueSet/body-site|4.0.1)

                                                                                  Codes describing anatomical locations. May include laterality.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  282. Observation.method
                                                                                  Definition

                                                                                  Konkrete Untersuchungsmethode, wenn der verwendete LOINC-Code für den Laborparameter keine Methode enthält.

                                                                                  ShortUntersuchungsmethode
                                                                                  Comments

                                                                                  Only used if not implicit in code for Observation.code.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see ObservationMethods
                                                                                  (example to http://hl7.org/fhir/ValueSet/observation-methods|4.0.1)

                                                                                  Methods for simple observations.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  284. Observation.method.id
                                                                                  Definition

                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  286. Observation.method.extension
                                                                                  Definition

                                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

                                                                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  SlicingThis element introduces a set of slices on Observation.method.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                  • value @ url
                                                                                  • 288. Observation.method.coding
                                                                                    Definition

                                                                                    A reference to a code defined by a terminology system.

                                                                                    ShortCode defined by a terminology system
                                                                                    Comments

                                                                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                    Control0..*
                                                                                    TypeCoding
                                                                                    Is Modifierfalse
                                                                                    Must Supporttrue
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    290. Observation.method.coding.id
                                                                                    Definition

                                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                    ShortUnique id for inter-element referencing
                                                                                    Control0..1
                                                                                    Typestring
                                                                                    Is Modifierfalse
                                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                                    Summaryfalse
                                                                                    292. Observation.method.coding.extension
                                                                                    Definition

                                                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                    ShortAdditional content defined by implementations
                                                                                    Comments

                                                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                    Control0..*
                                                                                    TypeExtension
                                                                                    Is Modifierfalse
                                                                                    Summaryfalse
                                                                                    Alternate Namesextensions, user content
                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                    SlicingThis element introduces a set of slices on Observation.method.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ url
                                                                                    • 294. Observation.method.coding.system
                                                                                      Definition

                                                                                      The identification of the code system that defines the meaning of the symbol in the code.

                                                                                      ShortIdentity of the terminology system
                                                                                      Comments

                                                                                      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                                      Control1..1
                                                                                      Typeuri
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Must Supporttrue
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Need to be unambiguous about the source of the definition of the symbol.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      296. Observation.method.coding.version
                                                                                      Definition

                                                                                      The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                                      ShortVersion of the system - if relevant
                                                                                      Comments

                                                                                      Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      298. Observation.method.coding.code
                                                                                      Definition

                                                                                      A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                                                                      ShortSymbol in syntax defined by the system
                                                                                      Control1..1
                                                                                      Typecode
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Must Supporttrue
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Need to refer to a particular code in the system.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      300. Observation.method.coding.display
                                                                                      Definition

                                                                                      A representation of the meaning of the code in the system, following the rules of the system.

                                                                                      ShortRepresentation defined by the system
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Must Supporttrue
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      302. Observation.method.coding.userSelected
                                                                                      Definition

                                                                                      Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                                      ShortIf this coding was chosen directly by the user
                                                                                      Comments

                                                                                      Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                                      Control0..1
                                                                                      Typeboolean
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      304. Observation.method.text
                                                                                      Definition

                                                                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                      ShortPlain text representation of the concept
                                                                                      Comments

                                                                                      Very often the text is the same as a displayName of one of the codings.

                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      306. Observation.specimen
                                                                                      Definition

                                                                                      Probe, auf deren Basis die Laboruntersuchungen angefertigt werden

                                                                                      ShortProbenmaterial
                                                                                      Comments

                                                                                      Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

                                                                                      Control0..1
                                                                                      TypeReference(Specimen)
                                                                                      Is Modifierfalse
                                                                                      Must Supporttrue
                                                                                      Summaryfalse
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      308. Observation.specimen.id
                                                                                      Definition

                                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                      ShortUnique id for inter-element referencing
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                      Summaryfalse
                                                                                      310. Observation.specimen.extension
                                                                                      Definition

                                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                      ShortAdditional content defined by implementations
                                                                                      Comments

                                                                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Is Modifierfalse
                                                                                      Summaryfalse
                                                                                      Alternate Namesextensions, user content
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      SlicingThis element introduces a set of slices on Observation.specimen.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 312. Observation.specimen.reference
                                                                                        Definition

                                                                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                        ShortLiteral reference, Relative, internal or absolute URL
                                                                                        Comments

                                                                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                        Control0..1
                                                                                        This element is affected by the following invariants: ref-1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        314. Observation.specimen.type
                                                                                        Definition

                                                                                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                        ShortType the reference refers to (e.g. "Patient")
                                                                                        Comments

                                                                                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                        Control0..1
                                                                                        BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                        (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                        Aa resource (or, for logical models, the URI of the logical model).

                                                                                        Typeuri
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Summarytrue
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        316. Observation.specimen.identifier
                                                                                        Definition

                                                                                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                        ShortLogical reference, when literal reference is not known
                                                                                        Comments

                                                                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                        Control0..1
                                                                                        TypeIdentifier
                                                                                        Is Modifierfalse
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        318. Observation.specimen.display
                                                                                        Definition

                                                                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                        ShortText alternative for the resource
                                                                                        Comments

                                                                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Summarytrue
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        320. Observation.device
                                                                                        Definition

                                                                                        Gerät, das zur Generierung der Messwerte verwendet wurde.

                                                                                        ShortGerät
                                                                                        Comments

                                                                                        Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

                                                                                        Control0..1
                                                                                        TypeReference(Device, DeviceMetric)
                                                                                        Is Modifierfalse
                                                                                        Must Supporttrue
                                                                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                        Summaryfalse
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        322. Observation.device.id
                                                                                        Definition

                                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        324. Observation.device.extension
                                                                                        Definition

                                                                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

                                                                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Alternate Namesextensions, user content
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        SlicingThis element introduces a set of slices on Observation.device.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • value @ url
                                                                                        • 326. Observation.device.reference
                                                                                          Definition

                                                                                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                                          ShortLiteral reference, Relative, internal or absolute URL
                                                                                          Comments

                                                                                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: ref-1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          328. Observation.device.type
                                                                                          Definition

                                                                                          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                                          ShortType the reference refers to (e.g. "Patient")
                                                                                          Comments

                                                                                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                                          Control0..1
                                                                                          BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                                          (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                                          Aa resource (or, for logical models, the URI of the logical model).

                                                                                          Typeuri
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          330. Observation.device.identifier
                                                                                          Definition

                                                                                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                                          ShortLogical reference, when literal reference is not known
                                                                                          Comments

                                                                                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                                          Control0..1
                                                                                          TypeIdentifier
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          332. Observation.device.display
                                                                                          Definition

                                                                                          Plain text narrative that identifies the resource in addition to the resource reference.

                                                                                          ShortText alternative for the resource
                                                                                          Comments

                                                                                          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          334. Observation.referenceRange
                                                                                          Definition

                                                                                          Bereich, in dem der Messwert als normal oder empfohlen betrachtet wird.

                                                                                          ShortReferenzbereich
                                                                                          Comments

                                                                                          Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                          Control0..*
                                                                                          TypeBackboneElement
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
                                                                                          336. Observation.referenceRange.id
                                                                                          Definition

                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                          ShortUnique id for inter-element referencing
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          Summaryfalse
                                                                                          338. Observation.referenceRange.extension
                                                                                          Definition

                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                          ShortAdditional content defined by implementations
                                                                                          Comments

                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Alternate Namesextensions, user content
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          340. Observation.referenceRange.modifierExtension
                                                                                          Definition

                                                                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                                                          Comments

                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                          Alternate Namesextensions, user content, modifiers
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          342. Observation.referenceRange.low
                                                                                          Definition

                                                                                          The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

                                                                                          ShortLow Range, if relevant
                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: obs-3
                                                                                          TypeQuantity(SimpleQuantity)
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          344. Observation.referenceRange.high
                                                                                          Definition

                                                                                          The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

                                                                                          ShortHigh Range, if relevant
                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: obs-3
                                                                                          TypeQuantity(SimpleQuantity)
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          346. Observation.referenceRange.type
                                                                                          Definition

                                                                                          Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

                                                                                          ShortReference range qualifier
                                                                                          Comments

                                                                                          This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

                                                                                          Control0..1
                                                                                          BindingThe codes SHOULD be taken from ObservationReferenceRangeMeaningCodes
                                                                                          (preferred to http://hl7.org/fhir/ValueSet/referencerange-meaning|4.0.1)

                                                                                          Code for the meaning of a reference range.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          348. Observation.referenceRange.appliesTo
                                                                                          Definition

                                                                                          Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

                                                                                          ShortReference range population
                                                                                          Comments

                                                                                          This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

                                                                                          Control0..*
                                                                                          BindingFor example codes, see ObservationReferenceRangeAppliesToCodes
                                                                                          (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto|4.0.1)

                                                                                          Codes identifying the population the reference range applies to.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          Need to be able to identify the target population for proper interpretation.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          350. Observation.referenceRange.age
                                                                                          Definition

                                                                                          The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

                                                                                          ShortApplicable age range, if relevant
                                                                                          Control0..1
                                                                                          TypeRange
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          Some analytes vary greatly over age.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          352. Observation.referenceRange.text
                                                                                          Definition

                                                                                          Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".

                                                                                          ShortText based reference range in an observation
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summaryfalse
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          354. Observation.hasMember
                                                                                          Definition

                                                                                          This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

                                                                                          ShortRelated resource that belongs to the Observation group
                                                                                          Comments

                                                                                          When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

                                                                                          Control0..*
                                                                                          TypeReference(Observation, QuestionnaireResponse, MolecularSequence)
                                                                                          Is Modifierfalse
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          356. Observation.derivedFrom
                                                                                          Definition

                                                                                          The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.

                                                                                          ShortRelated measurements the observation is made from
                                                                                          Comments

                                                                                          All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

                                                                                          Control0..*
                                                                                          TypeReference(DocumentReference, ImagingStudy, Media, QuestionnaireResponse, Observation, MolecularSequence)
                                                                                          Is Modifierfalse
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          358. Observation.component
                                                                                          Definition

                                                                                          Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

                                                                                          ShortComponent results
                                                                                          Comments

                                                                                          For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                                                          Control0..*
                                                                                          TypeBackboneElement
                                                                                          Is Modifierfalse
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          360. Observation.component.id
                                                                                          Definition

                                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                          ShortUnique id for inter-element referencing
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          Summaryfalse
                                                                                          362. Observation.component.extension
                                                                                          Definition

                                                                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                                          ShortAdditional content defined by implementations
                                                                                          Comments

                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Alternate Namesextensions, user content
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          364. Observation.component.modifierExtension
                                                                                          Definition

                                                                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                                                          Comments

                                                                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                                                          Alternate Namesextensions, user content, modifiers
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          366. Observation.component.code
                                                                                          Definition

                                                                                          Describes what was observed. Sometimes this is called the observation "code".

                                                                                          ShortType of component observation (code / type)
                                                                                          Comments

                                                                                          All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

                                                                                          Control1..1
                                                                                          BindingFor example codes, see LOINCCodes
                                                                                          (example to http://hl7.org/fhir/ValueSet/observation-codes|4.0.1)

                                                                                          Codes identifying names of simple observations.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Knowing what kind of observation is being made is essential to understanding the observation.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          368. Observation.component.value[x]
                                                                                          Definition

                                                                                          The information determined as a result of making the observation, if the information has a simple value.

                                                                                          ShortActual component result
                                                                                          Comments

                                                                                          Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

                                                                                          Control0..1
                                                                                          TypeChoice of: Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period
                                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          370. Observation.component.dataAbsentReason
                                                                                          Definition

                                                                                          Provides a reason why the expected value in the element Observation.component.value[x] is missing.

                                                                                          ShortWhy the component result is missing
                                                                                          Comments

                                                                                          "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

                                                                                          The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

                                                                                          Control0..1
                                                                                          This element is affected by the following invariants: obs-6
                                                                                          BindingUnless not suitable, these codes SHALL be taken from DataAbsentReason
                                                                                          (extensible to http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1)

                                                                                          Codes specifying why the result (Observation.value[x]) is missing.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          For many results it is necessary to handle exceptional values in measurements.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          372. Observation.component.interpretation
                                                                                          Definition

                                                                                          A categorical assessment of an observation value. For example, high, low, normal.

                                                                                          ShortHigh, low, normal, etc.
                                                                                          Comments

                                                                                          Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

                                                                                          Control0..*
                                                                                          BindingUnless not suitable, these codes SHALL be taken from ObservationInterpretationCodes
                                                                                          (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation|4.0.1)

                                                                                          Codes identifying interpretations of observations.

                                                                                          TypeCodeableConcept
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

                                                                                          Alternate NamesAbnormal Flag
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          374. Observation.component.referenceRange
                                                                                          Definition

                                                                                          Guidance on how to interpret the value by comparison to a normal or recommended range.

                                                                                          ShortProvides guide for interpretation of component result
                                                                                          Comments

                                                                                          Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

                                                                                          Control0..*
                                                                                          TypeSeettp://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Requirements

                                                                                          Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))