RIVO-Noord Zorgviewer Implementation Guide
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RIVO-Noord Zorgviewer Implementation Guide - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: LaboratoryTestResult - Detailed Descriptions

Draft as of 2024-06-21

Definitions for the LaboratoryTestResult resource profile.

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

0. Observation
2. Observation.status
Must Supporttrue
4. Observation.code
6. Observation.code.text
Must Supporttrue
8. Observation.effectiveDateTime
Must Supporttrue
10. Observation.valueQuantity
Must Supporttrue
12. Observation.valueQuantity.value
Must Supporttrue
14. Observation.valueQuantity.unit
Must Supporttrue
16. Observation.interpretation
18. Observation.interpretation.coding
20. Observation.interpretation.coding.code
Must Supporttrue
22. Observation.interpretation.text
Must Supporttrue
24. Observation.specimen
TypeReference(Specimen)
Must Supporttrue
26. Observation.referenceRange
28. Observation.referenceRange.low
30. Observation.referenceRange.low.value
Must Supporttrue
32. Observation.referenceRange.low.unit
Must Supporttrue
34. Observation.referenceRange.high
36. Observation.referenceRange.high.value
Must Supporttrue
38. Observation.referenceRange.high.unit
Must Supporttrue

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

0. Observation
Definition

A laboratory result describes the result of a laboratory analysis. These are specimen-oriented tests as performed in laboratories such as Clinical Chemistry, Serology, Microbiology, etc. In addition to the results of tests with a singular result, this concept can also contain the results of more complex tests with multiple results or a ‘panel’.


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

ShortLaboratoryTestResultMeasurements and simple assertions
Comments

This profile is used for two concepts of the HCIM LaboratoryTestResult at the same time: the root concept (NL-CM:13.1.1) and the LaboratoryTest concept (NL-CM:13.1.3). A LaboratoryTestResult can consist of just one LaboratoryTest or can be a panel of multiple LaboratoryTests. If there's just one LaboratoryTest, a single instance of this profile may be used to represent both concepts, but if there are multiple LaboratoryTests, there should be one parent instance representing the LaboratoryTestResult that uses Observation.related to link child instances representing individual LaboratoryTests.

Note that the Observation.related field in is also used for a third case where there are multiple related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33).

The list below summarizes the different situations: 1. Single LaboratoryTestResult with single LaboratoryTest: * single instance of this profile * .code represents the HCIM concept TestCode (NL-CM:13.1.8) 2. Single LaboratoryTestResult with multiple LaboratoryTests * parent instance with child instances in .related.target * .code of parent represents the HCIM concept PanelOrBattery (NL-CM:13.1.4) * .code of child represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.type of parent set to "has-member" 3. Multiple related LaboratoryTestResults * multiple instances representing the root concept * .code represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.target references the related instances * .related.type set to whichever value is appropriate

Also note that there is the additional profile zib-LaboratoryTestResult-DiagnosticReport, which is used for (textual) reports on individual (panels of) observations, like conclusions. The DiagnosticReport contains references to instances of this profile and can be used in all three the situations described above.


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 lab reports, etc.

Control0..*
Alternate NamesVital Signs, Measurement, Results, Tests, LaboratoriumUitslag
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.empty())
2. 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.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. Observation.modifierExtension
Definition

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. Usually modifier elements provide negation or qualification. In order 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.

ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
Alternate Namesextensions, user content
6. Observation.status
Definition

The status of the test result of this test. If the laboratory test is an panel/cluster, the overall status is given in the status of the panel/cluster.


The status of the result value.

ShortTestUitslagStatusregistered | 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
(required to http://hl7.org/fhir/ValueSet/observation-status)

Codes providing the status of an observation.

Typecode
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
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.

Alternate NamesTestUitslagStatus
8. Observation.status.extension:TestResultStatus
Slice NameTestResultStatus
Definition

Provides the specific HCIM code for TestResultStatus or ResultStatus.

The status of the laboratory test result. If the laboratory test is an panel/cluster, this status reflects the status of the whole panel/cluster. If the status item per subtest is used too, this status must be in accordance with these status values.

ShortTestResultStatus
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., TestUitslagStatus
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. Observation.status.extension:TestResultStatus.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Shortidentifies the meaning of the extension
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Control1..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
12. Observation.status.extension:TestResultStatus.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control10..1
TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
SlicingThis element introduces a set of slices on Observation.status.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
  • 14. Observation.status.extension:TestResultStatus.value[x]:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control10..1
    BindingUnless not suitable, these codes SHALL be taken from For codes, see ResultaatStatusCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000)

    TestResultStatusCodelist

    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    16. Observation.category
    Definition

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

    ShortClassification 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 Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category
    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

    Codes for high level observation categories.

    TypeCodeableConcept
    Requirements

    Used for filtering what observations are retrieved and displayed.

    SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ $this
    • 18. Observation.category:LaboratoryTestResultCode
      Slice NameLaboratoryTestResultCode
      Definition

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

      ShortLaboratoryTestResultCodeClassification 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 Observation Category Codeshttp://hl7.org/fhir/ValueSet/observation-category
      (preferred to http://hl7.org/fhir/ValueSet/observation-category)

      Codes for high level observation categories.

      TypeCodeableConcept
      Requirements

      Used for filtering what observations are retrieved and displayed.

      Pattern Value{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "49581000146104"
        }]
      }
      20. Observation.category:ResultType
      Slice NameResultType
      Definition

      The type of result defines the laboratory specialty under which the test is categorized.


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

      ShortResultTypeClassification 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.

      Control0..1*
      BindingThe codes SHALL be taken from The codes SHOULD be taken from ResultaatTypeCodelijsthttp://hl7.org/fhir/ValueSet/observation-category
      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000)

      ResultaatTypeCodelijst


      Codes for high level observation categories.

      TypeCodeableConcept
      Requirements

      Used for filtering what observations are retrieved and displayed.

      Alternate NamesResultaatType
      22. Observation.code
      Definition

      The name and code of the executed test or for laboratory tests comprising multiple subtests and often requested together as a whole, this concept contains the name of the compound request (often indicated as a ‘panel’, ‘battery’ or ‘cluster’). Examples include: blood gases and EBV serology.


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

      ShortTestCode or PanelOrBatteryType of observation (code / type)
      Comments

      This can either be the HCIM concept PanelOrBattery (NL-CM:13.1.4) or TestCode (NL-CM:13.1.8) depending on the use case. See the documentation on the root of this profile for guidance on implementing the different uses cases.

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

      Codes identifying names of simple observations.

      TypeCodeableConcept
      Summarytrue
      Requirements

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

      Alternate NamesName, TestCode, Onderzoek
      24. 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      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.

      26. Observation.subject
      Definition

      The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.

      ShortPatientWho and/or what this 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.

      If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.

      Control10..1
      TypeReference(Group, Device, nl-core-location, nl-core-patient, Patient, Location)
      Summarytrue
      Requirements

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

      Alternate NamesPatiënt
      28. Observation.effective[x]
      Definition

      The date and if possible the time at which the test was carried out.


      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.

      ShortTestDateTimeClinically relevant time/time-period for observation
      Comments

      At least a date should be present unless this observation is a historical report.

      Control0..1
      TypedateTime, Period
      [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
      Summarytrue
      Requirements

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

      Alternate NamesOccurrence, TestDatumTijd
      SlicingThis element introduces a set of slices on Observation.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 30. Observation.effective[x]:effectiveDateTime
        Slice NameeffectiveDateTime
        Definition

        The date and if possible the time at which the test was carried out.


        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.

        ShortTestDateTimeClinically relevant time/time-period for observation
        Comments

        At least a date should be present unless this observation is a historical report.

        Control0..1
        TypedateTime, Period
        [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
        Summarytrue
        Requirements

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

        Alternate NamesOccurrence, TestDatumTijd
        32. Observation.value[x]
        Definition

        The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).


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

        ShortTestResultActual result
        Comments

        Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

        If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.

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

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

        Alternate NamesTestUitslag
        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
        • 34. Observation.value[x]:valueQuantity
          Slice NamevalueQuantity
          Definition

          The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).


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

          ShortTestResultActual result
          Comments

          Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

          If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.

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

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

          Alternate NamesTestUitslag
          36. 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).

          Control0..1
          Typedecimal
          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.

          38. 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
          Comments

          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.

          Control0..1
          BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
          (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

          How the Quantity should be understood and represented.

          Typecode
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          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
          40. Observation.value[x]:valueQuantity.unit
          Definition

          A human-readable form of the unit.

          ShortUnit representation
          Control0..1
          Typestring
          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.

          42. Observation.interpretation
          Definition

          The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

          ShortHigh, low, normal, etc.
          Control0..1
          BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codeshttp://hl7.org/fhir/ValueSet/observation-interpretation
          (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

          Codes identifying interpretations of observations.

          TypeCodeableConcept
          Requirements

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

          Alternate NamesAbnormal Flag
          44. Observation.interpretation.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
          Summarytrue
          Requirements

          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

          Invariantszib-LaboratoryTestResult-Observation-1: If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values. (coding.where(system = 'http://snomed.info/sct' and (code = '281302008' or '281300000' or '11896004' or '30714006' or '131196009') ).exists() implies coding.where(system = 'http://hl7.org/fhir/v2/0078').exists())
          SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ system
          • 46. Observation.interpretation.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
            Control0..1
            Typecode
            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.

            48. Observation.interpretation.coding:ObservationInterpretation
            Slice NameObservationInterpretation
            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..*
            BindingThe codes SHALL be taken from For codes, see Observation Interpretation Codes
            (required to http://hl7.org/fhir/ValueSet/observation-interpretation)

            Observation Interpretation Codes

            TypeCoding
            Summarytrue
            Requirements

            Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

            50. Observation.interpretation.coding:ObservationInterpretation.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

            Fixed Valuehttp://hl7.org/fhir/v2/0078
            52. Observation.interpretation.coding:ObservationInterpretation.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
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            54. Observation.interpretation.coding:InterpretatieVlaggenCodelijst
            Slice NameInterpretatieVlaggenCodelijst
            Definition

            Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)


            A reference to a code defined by a terminology system.

            ShortResultFlagsCode defined by a terminology system
            Comments

            This slice binds the ValueSet from the HCIM, which overlaps the ValueSet from the core FHIR Observation. To satisfy the FHIR profiling rules, the code from the core FHIR ValueSet SHOULD be included as well if a code from this ValueSet is included. A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that explains the relationship between the FHIR observation-interpretation value set and the HCIM ResultFlagsCodelist.


            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..*
            BindingThe codes SHALL be taken from For codes, see InterpretatieVlaggenCodelijst
            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

            InterpretatieVlaggenCodelijst

            TypeCoding
            Summarytrue
            Requirements

            Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

            Alternate NamesInterpretatieVlaggen
            56. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

            Fixed Valuehttp://snomed.info/sct
            58. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            60. Observation.interpretation.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
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            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.

            62. Observation.specimen
            Definition

            The specimen that was used when this observation was made.

            ShortSpecimenSpecimen 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, Specimen)
            Must Supporttrue
            Alternate NamesMonster
            64. Observation.referenceRange
            Definition

            Guidance on how to interpret the value by comparison to a normal or recommended range.

            ShortReferenceProvides 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 may 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
            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.

            Alternate NamesReferentie
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (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())
            ele-1: All FHIR elements must have a @value or children (hasValue() | (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())
            66. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

            ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
            Summarytrue
            Alternate Namesextensions, user content, modifiers
            68. Observation.referenceRange.low
            Definition

            The lower reference limit for the patient of the value measured with the test.


            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).

            ShortReferenceRangeLowerLimitLow Range, if relevant
            Control0..1
            This element is affected by the following invariants: obs-3
            TypeQuantity(SimpleQuantity)
            Alternate NamesReferentieOndergrens
            70. Observation.referenceRange.low.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).

            Control0..1
            Typedecimal
            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.

            72. Observation.referenceRange.low.comparator
            Definition

            Not allowed to be used in this context


            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
            Comments

            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.

            Control0..01
            BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
            (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

            How the Quantity should be understood and represented.

            Typecode
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            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
            74. Observation.referenceRange.low.unit
            Definition

            A human-readable form of the unit.

            ShortUnit representation
            Control0..1
            Typestring
            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.

            76. Observation.referenceRange.high
            Definition

            The upper reference limit for the patient of the value measured in the test.


            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).

            ShortReferenceRangeUpperLimitHigh Range, if relevant
            Control0..1
            This element is affected by the following invariants: obs-3
            TypeQuantity(SimpleQuantity)
            Alternate NamesReferentieBovengrens
            78. Observation.referenceRange.high.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).

            Control0..1
            Typedecimal
            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.

            80. Observation.referenceRange.high.comparator
            Definition

            Not allowed to be used in this context


            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
            Comments

            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.

            Control0..01
            BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator
            (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

            How the Quantity should be understood and represented.

            Typecode
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            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
            82. Observation.referenceRange.high.unit
            Definition

            A human-readable form of the unit.

            ShortUnit representation
            Control0..1
            Typestring
            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.

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

            0. Observation
            Definition

            A laboratory result describes the result of a laboratory analysis. These are specimen-oriented tests as performed in laboratories such as Clinical Chemistry, Serology, Microbiology, etc. In addition to the results of tests with a singular result, this concept can also contain the results of more complex tests with multiple results or a ‘panel’.

            ShortLaboratoryTestResult
            Comments

            This profile is used for two concepts of the HCIM LaboratoryTestResult at the same time: the root concept (NL-CM:13.1.1) and the LaboratoryTest concept (NL-CM:13.1.3). A LaboratoryTestResult can consist of just one LaboratoryTest or can be a panel of multiple LaboratoryTests. If there's just one LaboratoryTest, a single instance of this profile may be used to represent both concepts, but if there are multiple LaboratoryTests, there should be one parent instance representing the LaboratoryTestResult that uses Observation.related to link child instances representing individual LaboratoryTests.

            Note that the Observation.related field in is also used for a third case where there are multiple related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33).

            The list below summarizes the different situations: 1. Single LaboratoryTestResult with single LaboratoryTest: * single instance of this profile * .code represents the HCIM concept TestCode (NL-CM:13.1.8) 2. Single LaboratoryTestResult with multiple LaboratoryTests * parent instance with child instances in .related.target * .code of parent represents the HCIM concept PanelOrBattery (NL-CM:13.1.4) * .code of child represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.type of parent set to "has-member" 3. Multiple related LaboratoryTestResults * multiple instances representing the root concept * .code represents the HCIM concept TestCode (NL-CM:13.1.8) * .related.target references the related instances * .related.type set to whichever value is appropriate

            Also note that there is the additional profile zib-LaboratoryTestResult-DiagnosticReport, which is used for (textual) reports on individual (panels of) observations, like conclusions. The DiagnosticReport contains references to instances of this profile and can be used in all three the situations described above.

            Control0..*
            Alternate NamesVital Signs, Measurement, Results, Tests, LaboratoriumUitslag
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
            obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present (value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty())
            obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present (dataAbsentReason.empty() or value.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
            Typeid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            4. Observation.meta
            Definition

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

            ShortMetadata about the resource
            Control0..1
            TypeMeta
            Summarytrue
            6. 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.

            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.

            This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

            Control0..1
            Typeuri
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            8. 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
            BindingUnless not suitable, these codes SHALL be taken from Common Languages
            (extensible to http://hl7.org/fhir/ValueSet/languages)

            A human language.

            Additional BindingsPurpose
            AllLanguagesMax Binding
            Typecode
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            10. Observation.text
            Definition

            A human-readable narrative that contains a summary of the resource, and may 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 in formation is added later.

            Control0..1
            This element is affected by the following invariants: dom-1
            TypeNarrative
            Alternate Namesnarrative, html, xhtml, display
            12. 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.

            Control0..*
            TypeResource
            Alternate Namesinline resources, anonymous resources, contained resources
            14. Observation.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

            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
            Alternate Namesextensions, user content
            16. Observation.modifierExtension
            Definition

            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. Usually modifier elements provide negation or qualification. In order 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.

            ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
            Alternate Namesextensions, user content
            18. Observation.identifier
            Definition

            A unique identifier assigned to this observation.

            ShortIdentifier
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Summarytrue
            Requirements

            Allows observations to be distinguished and referenced.

            Alternate NamesIdentificatie
            20. Observation.basedOn
            Definition

            A plan, proposal or order that is fulfilled in whole or in part by this event.

            ShortFulfills plan, proposal or order including requester information.
            Comments

            Requester information should be captured and exchanged in the resource ProcedureRequest referenced by basedOn. Requester is the healthcare provider and/or organization where or by whom the LaboratoryTestResult was requested. There are a few required elements in ProcedureRequest: * ProcedureRequest.status (use fixed value active, unless you know what the actual value is) * ProcedureRequest.intent (use fixed value order, unless you know what the actual value is) * ProcedureRequest.code (use extension http://hl7.org/fhir/STU3/extension-iso21090-nullflavor.html with valueCode UNK, unless you know what the actual value is) * ProcedureRequest.subject (equal to Observation.subject) * ProcedureRequest.requester.agent (contains the requesting HealthProfessional)

            Control0..*
            TypeReference(CarePlan, DeviceRequest, ImmunizationRecommendation, MedicationRequest, NutritionOrder, ProcedureRequest, ReferralRequest)
            Summarytrue
            Requirements

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

            Alternate NamesFulfills, Aanvrager
            22. Observation.status
            Definition

            The status of the test result of this test. If the laboratory test is an panel/cluster, the overall status is given in the status of the panel/cluster.

            ShortTestUitslagStatus
            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)

            Codes providing the status of an observation.

            Typecode
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            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.

            Alternate NamesTestUitslagStatus
            24. Observation.status.id
            Definition

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

            Shortxml:id (or equivalent in JSON)
            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            26. Observation.status.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            SlicingThis element introduces a set of slices on Observation.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 28. Observation.status.extension:TestResultStatus
              Slice NameTestResultStatus
              Definition

              Provides the specific HCIM code for TestResultStatus or ResultStatus.

              The status of the laboratory test result. If the laboratory test is an panel/cluster, this status reflects the status of the whole panel/cluster. If the status item per subtest is used too, this status must be in accordance with these status values.

              ShortTestResultStatus
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
              Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., TestUitslagStatus
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              30. Observation.status.extension:TestResultStatus.id
              Definition

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

              Shortxml:id (or equivalent in JSON)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              32. Observation.status.extension:TestResultStatus.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

              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
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Observation.status.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 34. Observation.status.extension:TestResultStatus.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/code-specification
                36. Observation.status.extension:TestResultStatus.value[x]
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortValue of extension
                Control1..1
                TypeCodeableConcept
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                SlicingThis element introduces a set of slices on Observation.status.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 38. Observation.status.extension:TestResultStatus.value[x]:valueCodeableConcept
                  Slice NamevalueCodeableConcept
                  Definition

                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                  ShortValue of extension
                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from ResultaatStatusCodelijst
                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.8--20171231000000)

                  TestResultStatusCodelist

                  TypeCodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  40. Observation.status.value
                  Definition

                  Primitive value for code

                  ShortPrimitive value for code
                  Control0..1
                  Typecode
                  XML FormatIn the XML format, this property is represented as an attribute.
                  42. Observation.category
                  Definition

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

                  ShortClassification 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.

                  Control1..*
                  BindingThe codes SHOULD be taken from Observation Category Codes
                  (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                  Codes for high level observation categories.

                  TypeCodeableConcept
                  Requirements

                  Used for filtering what observations are retrieved and displayed.

                  SlicingThis element introduces a set of slices on Observation.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ $this
                  • 44. Observation.category:LaboratoryTestResultCode
                    Slice NameLaboratoryTestResultCode
                    Definition

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

                    ShortLaboratoryTestResultCode
                    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 Observation Category Codes
                    (preferred to http://hl7.org/fhir/ValueSet/observation-category)

                    Codes for high level observation categories.

                    TypeCodeableConcept
                    Requirements

                    Used for filtering what observations are retrieved and displayed.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://snomed.info/sct",
                        "code" : "49581000146104"
                      }]
                    }
                    46. Observation.category:LaboratoryTestResultCode.id
                    Definition

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

                    Shortxml:id (or equivalent in JSON)
                    Control0..1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    48. Observation.category:LaboratoryTestResultCode.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                    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
                    Alternate Namesextensions, user content
                    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
                    • 50. Observation.category:LaboratoryTestResultCode.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
                      Summarytrue
                      Requirements

                      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                      52. Observation.category:LaboratoryTestResultCode.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.

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      54. Observation.category:LaboratoryTestResultCode.coding.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                      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
                      Alternate Namesextensions, user content
                      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
                      • 56. Observation.category:LaboratoryTestResultCode.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

                        58. Observation.category:LaboratoryTestResultCode.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
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        60. Observation.category:LaboratoryTestResultCode.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
                        Control0..1
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        62. Observation.category:LaboratoryTestResultCode.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
                        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.

                        64. Observation.category:LaboratoryTestResultCode.coding.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - i.e. 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
                        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.

                        66. Observation.category:LaboratoryTestResultCode.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
                        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.

                        68. Observation.category:ResultType
                        Slice NameResultType
                        Definition

                        The type of result defines the laboratory specialty under which the test is categorized.

                        ShortResultType
                        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.

                        Control0..1
                        BindingThe codes SHALL be taken from ResultaatTypeCodelijst
                        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.1--20171231000000)

                        ResultaatTypeCodelijst

                        TypeCodeableConcept
                        Requirements

                        Used for filtering what observations are retrieved and displayed.

                        Alternate NamesResultaatType
                        70. Observation.code
                        Definition

                        The name and code of the executed test or for laboratory tests comprising multiple subtests and often requested together as a whole, this concept contains the name of the compound request (often indicated as a ‘panel’, ‘battery’ or ‘cluster’). Examples include: blood gases and EBV serology.

                        ShortTestCode or PanelOrBattery
                        Comments

                        This can either be the HCIM concept PanelOrBattery (NL-CM:13.1.4) or TestCode (NL-CM:13.1.8) depending on the use case. See the documentation on the root of this profile for guidance on implementing the different uses cases.

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

                        Codes identifying names of simple observations.

                        TypeCodeableConcept
                        Summarytrue
                        Requirements

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

                        Alternate NamesName, TestCode, Onderzoek
                        72. 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.

                        Shortxml:id (or equivalent in JSON)
                        Control0..1
                        Typestring
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        74. Observation.code.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                        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
                        Alternate Namesextensions, user content
                        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
                        • 76. 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
                          Summarytrue
                          Requirements

                          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                          78. 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
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          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.

                          80. Observation.subject
                          Definition

                          The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.

                          ShortPatient
                          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.

                          If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.

                          Control1..1
                          TypeReference(Group, Device, nl-core-location, nl-core-patient)
                          Summarytrue
                          Requirements

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

                          Alternate NamesPatiënt
                          82. Observation.context
                          Definition

                          The encounter during which this journal entry was made.

                          ShortEncounter 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 or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).

                          Control0..1
                          TypeReference(nl-core-episodeofcare, HCIM Encounter, gp-Encounter)
                          Requirements

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

                          Alternate NamesEncounter
                          84. Observation.effective[x]
                          Definition

                          The date and if possible the time at which the test was carried out.

                          ShortTestDateTime
                          Comments

                          At least a date should be present unless this observation is a historical report.

                          Control0..1
                          TypedateTime
                          [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
                          Summarytrue
                          Requirements

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

                          Alternate NamesOccurrence, TestDatumTijd
                          SlicingThis element introduces a set of slices on Observation.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 86. Observation.effective[x]:effectiveDateTime
                            Slice NameeffectiveDateTime
                            Definition

                            The date and if possible the time at which the test was carried out.

                            ShortTestDateTime
                            Comments

                            At least a date should be present unless this observation is a historical report.

                            Control0..1
                            TypedateTime
                            [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
                            Summarytrue
                            Requirements

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

                            Alternate NamesOccurrence, TestDatumTijd
                            88. Observation.issued
                            Definition

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

                            ShortDate/Time this was made available
                            Comments

                            Updated when the result is updated.

                            Control0..1
                            Typeinstant
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            90. Observation.performer
                            Definition

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

                            ShortWho is responsible for the observation
                            Control0..*
                            TypeReference(nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                            Summarytrue
                            Requirements

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

                            92. Observation.performer.id
                            Definition

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

                            Shortxml:id (or equivalent in JSON)
                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            94. Observation.performer.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control0..*
                            TypeExtension
                            SlicingThis element introduces a set of slices on Observation.performer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 96. Observation.performer.extension:practitionerRole
                              Slice NamepractitionerRole
                              Definition

                              Optional Extension Element - found in all resources.

                              ShortOptional Extensions Element
                              Control0..1
                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                              98. Observation.performer.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
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              100. Observation.performer.identifier
                              Definition

                              An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..1
                              TypeIdentifier
                              Summarytrue
                              102. Observation.performer.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
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              104. Observation.value[x]
                              Definition

                              The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

                              ShortTestResult
                              Comments

                              Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

                              If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples 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]
                              Summarytrue
                              Requirements

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

                              Alternate NamesTestUitslag
                              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 test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

                                ShortTestResult
                                Comments

                                Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

                                If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples 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]
                                Must Supporttrue
                                Summarytrue
                                Requirements

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

                                Alternate NamesTestUitslag
                                108. 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.

                                Shortxml:id (or equivalent in JSON)
                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                110. Observation.value[x]:valueQuantity.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                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
                                Alternate Namesextensions, user content
                                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
                                • 112. 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).

                                  Control0..1
                                  Typedecimal
                                  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.

                                  114. 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
                                  Comments

                                  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.

                                  Control0..1
                                  BindingThe codes SHALL be taken from QuantityComparator
                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                                  How the Quantity should be understood and represented.

                                  Typecode
                                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  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
                                  116. Observation.value[x]:valueQuantity.unit
                                  Definition

                                  A human-readable form of the unit.

                                  ShortUnit representation
                                  Control0..1
                                  Typestring
                                  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.

                                  118. 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
                                  Control0..1
                                  This element is affected by the following invariants: qty-3
                                  Typeuri
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

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

                                  120. 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 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.

                                  Control0..1
                                  Typecode
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  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.

                                  122. Observation.dataAbsentReason
                                  Definition

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

                                  ShortWhy 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 Observation Value Absent Reason
                                  (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

                                  TypeCodeableConcept
                                  Requirements

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

                                  124. Observation.interpretation
                                  Definition

                                  The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

                                  ShortHigh, low, normal, etc.
                                  Control0..1
                                  BindingUnless not suitable, these codes SHALL be taken from Observation Interpretation Codes
                                  (extensible to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                  Codes identifying interpretations of observations.

                                  TypeCodeableConcept
                                  Requirements

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

                                  Alternate NamesAbnormal Flag
                                  126. Observation.interpretation.id
                                  Definition

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

                                  Shortxml:id (or equivalent in JSON)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  128. Observation.interpretation.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                  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
                                  Alternate Namesextensions, user content
                                  SlicingThis element introduces a set of slices on Observation.interpretation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 130. Observation.interpretation.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
                                    Summarytrue
                                    Requirements

                                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                    Invariantszib-LaboratoryTestResult-Observation-1: If a value from the HCIM ValueSet 'InterpretatieVlaggenCodelijst' is present a mapped code from the FHIR ValueSet 'Observation Interpretation Codes' is also expected. A ConceptMap is available that maps the HCIM values to the FHIR values. (coding.where(system = 'http://snomed.info/sct' and (code = '281302008' or '281300000' or '11896004' or '30714006' or '131196009') ).exists() implies coding.where(system = 'http://hl7.org/fhir/v2/0078').exists())
                                    SlicingThis element introduces a set of slices on Observation.interpretation.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ system
                                    • 132. Observation.interpretation.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.

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      134. Observation.interpretation.coding.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                      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
                                      Alternate Namesextensions, user content
                                      SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 136. Observation.interpretation.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

                                        138. Observation.interpretation.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
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        140. Observation.interpretation.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
                                        Control0..1
                                        Typecode
                                        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.

                                        142. Observation.interpretation.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
                                        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.

                                        144. Observation.interpretation.coding.userSelected
                                        Definition

                                        Indicates that this coding was chosen by a user directly - i.e. 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
                                        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.

                                        146. Observation.interpretation.coding:ObservationInterpretation
                                        Slice NameObservationInterpretation
                                        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..*
                                        BindingThe codes SHALL be taken from Observation Interpretation Codes
                                        (required to http://hl7.org/fhir/ValueSet/observation-interpretation)

                                        Observation Interpretation Codes

                                        TypeCoding
                                        Summarytrue
                                        Requirements

                                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                        148. Observation.interpretation.coding:ObservationInterpretation.id
                                        Definition

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

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        150. Observation.interpretation.coding:ObservationInterpretation.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                        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
                                        Alternate Namesextensions, user content
                                        SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 152. Observation.interpretation.coding:ObservationInterpretation.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

                                          Fixed Valuehttp://hl7.org/fhir/v2/0078
                                          154. Observation.interpretation.coding:ObservationInterpretation.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
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          156. Observation.interpretation.coding:ObservationInterpretation.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
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need to refer to a particular code in the system.

                                          158. Observation.interpretation.coding:ObservationInterpretation.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
                                          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.

                                          160. Observation.interpretation.coding:ObservationInterpretation.userSelected
                                          Definition

                                          Indicates that this coding was chosen by a user directly - i.e. 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
                                          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.

                                          162. Observation.interpretation.coding:InterpretatieVlaggenCodelijst
                                          Slice NameInterpretatieVlaggenCodelijst
                                          Definition

                                          Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

                                          ShortResultFlags
                                          Comments

                                          This slice binds the ValueSet from the HCIM, which overlaps the ValueSet from the core FHIR Observation. To satisfy the FHIR profiling rules, the code from the core FHIR ValueSet SHOULD be included as well if a code from this ValueSet is included. A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that explains the relationship between the FHIR observation-interpretation value set and the HCIM ResultFlagsCodelist.

                                          Control0..*
                                          BindingThe codes SHALL be taken from InterpretatieVlaggenCodelijst
                                          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

                                          InterpretatieVlaggenCodelijst

                                          TypeCoding
                                          Summarytrue
                                          Requirements

                                          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                          Alternate NamesInterpretatieVlaggen
                                          164. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.id
                                          Definition

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

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          166. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                          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
                                          Alternate Namesextensions, user content
                                          SlicingThis element introduces a set of slices on Observation.interpretation.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 168. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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 de-reference to some definition that establish the system clearly and unambiguously.

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

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

                                            Fixed Valuehttp://snomed.info/sct
                                            170. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            172. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            Need to refer to a particular code in the system.

                                            174. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.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
                                            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.

                                            176. Observation.interpretation.coding:InterpretatieVlaggenCodelijst.userSelected
                                            Definition

                                            Indicates that this coding was chosen by a user directly - i.e. 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
                                            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.

                                            178. Observation.interpretation.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
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            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.

                                            180. Observation.comment
                                            Definition

                                            Comments, such as a textual interpretation or advice accompanying the result, for example or a comment of the laboratory specialist regarding the interpretation of the results.

                                            ShortComment or ResultInterpretation
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Requirements

                                            Need to be able to provide free text additional information.

                                            Alternate NamesToelichting, UitslagInterpretatie
                                            182. 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 body-site-instance.

                                            Control0..1
                                            BindingFor example codes, see SNOMED CT Body Structures
                                            (example to http://hl7.org/fhir/ValueSet/body-site)

                                            Codes describing anatomical locations. May include laterality.

                                            TypeCodeableConcept
                                            184. Observation.method
                                            Definition

                                            The test method used to obtain the result.

                                            ShortTestMethod
                                            Comments

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

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from TestmethodeCodelijst
                                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.4--20171231000000)

                                            SNOMED CT (2.16.840.1.113883.6.96): All values

                                            TypeCodeableConcept
                                            Requirements

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

                                            Alternate NamesTestmethode
                                            186. Observation.specimen
                                            Definition

                                            The specimen that was used when this observation was made.

                                            ShortSpecimen
                                            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)
                                            Must Supporttrue
                                            Alternate NamesMonster
                                            188. Observation.device
                                            Definition

                                            The device used to generate the observation data.

                                            Short(Measurement) Device
                                            Comments

                                            An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.

                                            Control0..1
                                            TypeReference(HCIM MedicalDevice Product)
                                            190. Observation.referenceRange
                                            Definition

                                            Guidance on how to interpret the value by comparison to a normal or recommended range.

                                            ShortReference
                                            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 may 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
                                            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.

                                            Alternate NamesReferentie
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (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())
                                            192. 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.

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            194. Observation.referenceRange.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                            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
                                            Alternate Namesextensions, user content
                                            196. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                            ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
                                            Summarytrue
                                            Alternate Namesextensions, user content, modifiers
                                            198. Observation.referenceRange.low
                                            Definition

                                            The lower reference limit for the patient of the value measured with the test.

                                            ShortReferenceRangeLowerLimit
                                            Control0..1
                                            This element is affected by the following invariants: obs-3
                                            TypeQuantity(SimpleQuantity)
                                            Alternate NamesReferentieOndergrens
                                            200. Observation.referenceRange.low.id
                                            Definition

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

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            202. Observation.referenceRange.low.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                            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
                                            Alternate Namesextensions, user content
                                            SlicingThis element introduces a set of slices on Observation.referenceRange.low.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 204. Observation.referenceRange.low.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).

                                              Control0..1
                                              Typedecimal
                                              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.

                                              206. Observation.referenceRange.low.comparator
                                              Definition

                                              Not allowed to be used in this context

                                              Short< | <= | >= | > - how to understand the value
                                              Comments

                                              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.

                                              Control0..0
                                              BindingThe codes SHALL be taken from QuantityComparator
                                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                                              How the Quantity should be understood and represented.

                                              Typecode
                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              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
                                              208. Observation.referenceRange.low.unit
                                              Definition

                                              A human-readable form of the unit.

                                              ShortUnit representation
                                              Control0..1
                                              Typestring
                                              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.

                                              210. Observation.referenceRange.low.system
                                              Definition

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

                                              ShortSystem that defines coded unit form
                                              Control0..1
                                              This element is affected by the following invariants: qty-3
                                              Typeuri
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

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

                                              212. Observation.referenceRange.low.code
                                              Definition

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

                                              ShortCoded form of the unit
                                              Comments

                                              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.

                                              Control0..1
                                              Typecode
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              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.

                                              214. Observation.referenceRange.high
                                              Definition

                                              The upper reference limit for the patient of the value measured in the test.

                                              ShortReferenceRangeUpperLimit
                                              Control0..1
                                              This element is affected by the following invariants: obs-3
                                              TypeQuantity(SimpleQuantity)
                                              Alternate NamesReferentieBovengrens
                                              216. Observation.referenceRange.high.id
                                              Definition

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

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              218. Observation.referenceRange.high.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                              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
                                              Alternate Namesextensions, user content
                                              SlicingThis element introduces a set of slices on Observation.referenceRange.high.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 220. Observation.referenceRange.high.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).

                                                Control0..1
                                                Typedecimal
                                                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.

                                                222. Observation.referenceRange.high.comparator
                                                Definition

                                                Not allowed to be used in this context

                                                Short< | <= | >= | > - how to understand the value
                                                Comments

                                                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.

                                                Control0..0
                                                BindingThe codes SHALL be taken from QuantityComparator
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator)

                                                How the Quantity should be understood and represented.

                                                Typecode
                                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                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
                                                224. Observation.referenceRange.high.unit
                                                Definition

                                                A human-readable form of the unit.

                                                ShortUnit representation
                                                Control0..1
                                                Typestring
                                                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.

                                                226. Observation.referenceRange.high.system
                                                Definition

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

                                                ShortSystem that defines coded unit form
                                                Control0..1
                                                This element is affected by the following invariants: qty-3
                                                Typeuri
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

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

                                                228. Observation.referenceRange.high.code
                                                Definition

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

                                                ShortCoded form of the unit
                                                Comments

                                                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.

                                                Control0..1
                                                Typecode
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                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.

                                                230. 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
                                                BindingUnless not suitable, these codes SHALL be taken from Observation Reference Range Meaning Codes
                                                (extensible to http://hl7.org/fhir/ValueSet/referencerange-meaning)

                                                Code for the meaning of a reference range.

                                                TypeCodeableConcept
                                                Requirements

                                                Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation.

                                                232. 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.

                                                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 Observation Reference Range Applies To Codes
                                                (example to http://hl7.org/fhir/ValueSet/referencerange-appliesto)

                                                Codes identifying the population the reference range applies to.

                                                TypeCodeableConcept
                                                Requirements

                                                Need to be able to identify the target population for proper interpretation.

                                                234. 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
                                                Requirements

                                                Some analytes vary greatly over age.

                                                236. 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
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                238. Observation.related
                                                Definition

                                                Reference to related LaboratoryTestResult instances, or to the LaboratoryTest concept if this is a grouping Observation.

                                                ShortRelatedResults
                                                Comments

                                                The Observation.related field is used for two different HCIM use cases: 1. The LaboratoryTestResult can reference other, related LaboratoryTestResults (RelatedResult, NL-CM:13.1.33). 2. The LaboratoryTestResult can consist of multiple LaboratoryTest concepts (NL-CM:13.1.3)

                                                See the documentation on the root if this profile for guidance on implementing these use cases.

                                                Control0..*
                                                TypeBackboneElement
                                                Summarytrue
                                                Requirements

                                                Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.

                                                Alternate NamesGerelateerdeUitslag, LaboratoriumTest
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                240. Observation.related.id
                                                Definition

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

                                                Shortxml:id (or equivalent in JSON)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                242. Observation.related.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                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
                                                Alternate Namesextensions, user content
                                                244. Observation.related.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
                                                Summarytrue
                                                Alternate Namesextensions, user content, modifiers
                                                246. Observation.related.type
                                                Definition

                                                A code specifying the kind of relationship that exists with the target resource.

                                                Shorthas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
                                                Comments

                                                The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.

                                                Control0..1
                                                BindingThe codes SHALL be taken from ObservationRelationshipType
                                                (required to http://hl7.org/fhir/ValueSet/observation-relationshiptypes)

                                                Codes specifying how two observations are related.

                                                Typecode
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Requirements

                                                A relationship type SHOULD be provided.

                                                248. Observation.related.target
                                                Definition

                                                A reference to the observation or QuestionnaireResponse resource that is related to this observation.

                                                ShortResource that is related to this one
                                                Control1..1
                                                TypeReference(QuestionnaireResponse, Sequence, HCIM LaboratoryTestResult Observation)
                                                250. Observation.component
                                                Definition

                                                Container of the LaboratoryTest concept. This container contains all data elements of the LaboratoryTest concept.

                                                ShortLaboratoryTest
                                                Comments

                                                For a discussion on the ways Observations can be assembled in groups together see Notes below.

                                                Control0..*
                                                TypeBackboneElement
                                                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.

                                                Alternate NamesLaboratoriumTest
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                252. 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.

                                                Shortxml:id (or equivalent in JSON)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                254. Observation.component.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                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
                                                Alternate Namesextensions, user content
                                                256. 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                ShortExtensions 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 No Modifier Reason provideed in previous versions of FHIR
                                                Summarytrue
                                                Alternate Namesextensions, user content, modifiers
                                                258. Observation.component.code
                                                Definition

                                                The TestCode is the name of the executed test.

                                                ShortTestCode
                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from TestCodeCodelijst
                                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.3--20171231000000)

                                                LOINC (2.16.840.1.113883.6.1): All values

                                                TypeCodeableConcept
                                                Summarytrue
                                                Requirements

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

                                                Alternate NamesTestCode
                                                260. Observation.component.value[x]
                                                Definition

                                                The test result. Depending on the type of test, the result will consist of a value with a unit or a coded value (ordinal or nominal).

                                                ShortTestResult
                                                Comments

                                                Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is 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 boolean values use valueCodeableConcept and select codes from <http://hl7.org/fhir/ValueSet/v2-0136> (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).

                                                Control0..1
                                                TypeChoice of: Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, Period
                                                [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
                                                Summarytrue
                                                Requirements

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

                                                Alternate NamesTestUitslag
                                                262. Observation.component.dataAbsentReason
                                                Definition

                                                Provides a reason why the expected value in the element Observation.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 Observation Value Absent Reason
                                                (extensible to http://hl7.org/fhir/ValueSet/observation-valueabsentreason)

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

                                                TypeCodeableConcept
                                                Requirements

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

                                                264. Observation.component.interpretation
                                                Definition

                                                Attention codes indicating whether the result is above or below certain reference values or interpreting the result otherwise. (Resistent)

                                                ShortResultFlags
                                                Comments

                                                A ConceptMap (https://simplifier.net/resolve?canonical=http://nictiz.nl/fhir/ConceptMap/InterpretatieVlaggenCodelijst-to-observation-interpretation) is available that maps ResultFlagsCodelist to the observation-interpretation value set.

                                                Control0..1
                                                BindingUnless not suitable, these codes SHALL be taken from InterpretatieVlaggenCodelijst
                                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.13.1.7--20171231000000)

                                                InterpretatieVlaggenCodelijst

                                                TypeCodeableConcept
                                                Requirements

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

                                                Alternate NamesAbnormal Flag, InterpretatieVlaggen
                                                266. 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 may 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
                                                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.