HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1 - Local Development build (v0.9.1). See the Directory of published versions

TNMPathologicStageGroup


<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="onco-core-TNMPathologicStageGroup"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
  <p><b>TNMPathologicStageGroup Profile</b></p>
  <p>The extent of the cancer in the body, according to the TNM classification system, based on examination of tissue samples removed during surgery, in addition to physical examination and imaging and potentially, other prognostic factors.</p>
  <p><b>Mapping Summary</b></p>
  <p><pre>onco.core.TNMPathologicStageGroup maps to Observation:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.source
  Metadata.Profile maps to meta.profile
  Metadata.LastUpdated maps to meta.lastUpdated
  Metadata.SecurityLabel maps to meta.security
  Metadata.Tag maps to meta.tag
  Narrative maps to text
  Identifier maps to identifier
  ObservationBasedOn maps to basedOn
  ObservationPartOf maps to partOf
  Status maps to status
  Category maps to category
  Code maps to code
  ObservationSubjectOfRecord maps to subject
  FocalSubject maps to focus
  CareContext maps to encounter
  RelevantTime maps to effective[x] // Add Types Timing, instant
  StatementDateTime maps to issued
  Performer maps to performer // Added Target Types PractitionerRole, CareTeam
  DataValue maps to value[x] // Add Type integer, remove Type Attachment
  DataAbsentReason maps to dataAbsentReason
  Interpretation maps to interpretation
  Annotation maps to note
  BodyLocation.Code maps to bodySite
  BodyLocation.Laterality maps to bodySite.extension
  BodyLocation.AnatomicalOrientation maps to bodySite.extension
  BodyLocation.RelationToLandmark maps to bodySite.extension
  CancerStagingSystem maps to method
  Specimen maps to specimen
  Device maps to device
  ReferenceRange maps to referenceRange
  ReferenceRange.LowerBound maps to referenceRange.low
  ReferenceRange.UpperBound maps to referenceRange.high
  ReferenceRange.Type maps to referenceRange.type
  ReferenceRange.ApplicableSubpopulation maps to referenceRange.appliesTo
  ReferenceRange.ApplicableAgeRange maps to referenceRange.age
  ReferenceRange.Text maps to referenceRange.text
  PanelMembers.Observation maps to hasMember (slice on = $this.resolve().code.coding.code; slice strategy = includes)
  ObservationDerivedFrom maps to derivedFrom
  Components.ObservationComponent maps to component (slice on = code.coding.code; slice strategy = includes)
  Components.ObservationComponent.Code maps to component.code
  Components.ObservationComponent.DataValue maps to component.value[x]
  Components.ObservationComponent.DataAbsentReason maps to component.dataAbsentReason
  Components.ObservationComponent.Interpretation maps to component.interpretation
  Components.ObservationComponent.ReferenceRange maps to component.referenceRange
  Components.ObservationComponent.ReferenceRange.LowerBound maps to component.referenceRange.low
  Components.ObservationComponent.ReferenceRange.UpperBound maps to component.referenceRange.high
  Components.ObservationComponent.ReferenceRange.Type maps to component.referenceRange.type
  Components.ObservationComponent.ReferenceRange.ApplicableSubpopulation maps to component.referenceRange.appliesTo
  Components.ObservationComponent.ReferenceRange.ApplicableAgeRange maps to component.referenceRange.age
  Components.ObservationComponent.ReferenceRange.Text maps to component.referenceRange.text
</pre></p>
</div>
  </text>
  <url
       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicStageGroup"/>
  <version value="0.9.1"/>
  <name value="TNMPathologicStageGroup"/>
  <title value="onco-core-TNMPathologicStageGroup"/>
  <status value="active"/>
  <date value="2019-08-01T00:00:00-04:00"/>
  <publisher value="HL7 International Clinical Interoperability Council"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cic"/>
    </telecom>
  </contact>
  <description
               value="The extent of the cancer in the body, according to the TNM classification system, based on examination of tissue samples removed during surgery, in addition to physical examination and imaging and potentially, other prognostic factors."/>
  <purpose
           value="Observations are a key aspect of healthcare.  This resource is used to capture those that do not require more sophisticated mechanisms."/>
  <fhirVersion value="4.0.0"/>
  <mapping>
    <identity value="workflow"/>
    <uri value="http://hl7.org/fhir/workflow"/>
    <name value="Workflow Pattern"/>
  </mapping>
  <mapping>
    <identity value="sct-concept"/>
    <uri value="http://snomed.info/conceptdomain"/>
    <name value="SNOMED CT Concept Domain Binding"/>
  </mapping>
  <mapping>
    <identity value="v2"/>
    <uri value="http://hl7.org/v2"/>
    <name value="HL7 v2 Mapping"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM Mapping"/>
  </mapping>
  <mapping>
    <identity value="w5"/>
    <uri value="http://hl7.org/fhir/fivews"/>
    <name value="FiveWs Pattern Mapping"/>
  </mapping>
  <mapping>
    <identity value="sct-attr"/>
    <uri value="http://snomed.org/attributebinding"/>
    <name value="SNOMED CT Attribute Binding"/>
  </mapping>
  <kind value="resource"/>
  <abstract value="false"/>
  <type value="Observation"/>
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation"/>
  <derivation value="constraint"/>
  <snapshot>
    <element id="Observation">
      <path value="Observation"/>
      <short value="onco-core-TNMPathologicStageGroup"/>
      <definition
                  value="The extent of the cancer in the body, according to the TNM classification system, based on examination of tissue samples removed during surgery, in addition to physical examination and imaging and potentially, other prognostic factors."/>
      <comment
               value="Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc.  Other resources are used to provide context for observations such as laboratory reports, etc."/>
      <alias value="Vital Signs"/>
      <alias value="Measurement"/>
      <alias value="Results"/>
      <alias value="Tests"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <constraint>
        <key value="dom-2"/>
        <severity value="error"/>
        <human
               value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
        <expression value="contained.contained.empty()"/>
        <xpath value="not(parent::f:contained and f:contained)"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-4"/>
        <severity value="error"/>
        <human
               value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
        <expression
                    value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
        <xpath
               value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-3"/>
        <severity value="error"/>
        <human
               value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource"/>
        <expression
                    value="contained.where(((&#39;#&#39;+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists()).not()).trace(&#39;unmatched&#39;, id).empty()"/>
        <xpath
               value="not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat(&#39;#&#39;, $contained/*/id/@value) or descendant::f:reference[@value=&#39;#&#39;])]))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown
                         value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
        </extension>
        <key value="dom-6"/>
        <severity value="warning"/>
        <human value="A resource should have narrative for robust management"/>
        <expression value="text.div.exists()"/>
        <xpath value="exists(f:text/h:div)"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-5"/>
        <severity value="error"/>
        <human
               value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
        <expression value="contained.meta.security.empty()"/>
        <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="obs-7"/>
        <severity value="error"/>
        <human
               value="If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present"/>
        <expression
                    value="value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()"/>
        <xpath
               value="not(f:*[starts-with(local-name(.), &#39;value&#39;)] and (for $coding in f:code/f:coding return f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@value]))"/>
      </constraint>
      <constraint>
        <key value="obs-6"/>
        <severity value="error"/>
        <human
               value="dataAbsentReason SHALL only be present if Observation.value[x] is not present"/>
        <expression value="dataAbsentReason.empty() or value.empty()"/>
        <xpath
               value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), &#39;value&#39;)])))"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Entity. Role, or Act"/>
      </mapping>
      <mapping>
        <identity value="workflow"/>
        <map value="Event"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 363787002 |Observable entity|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Observation[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.id">
      <path value="Observation.id"/>
      <short value="Logical id of this artifact"/>
      <definition
                  value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
      <comment
               value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta">
      <path value="Observation.meta"/>
      <short value="Metadata about the resource"/>
      <definition
                  value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.implicitRules">
      <path value="Observation.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition
                  value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
      <comment
               value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it&#39;s narrative along with other profiles, value sets, etc."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.language">
      <path value="Observation.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comment
               value="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)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true"/>
        </extension>
        <strength value="preferred"/>
        <description value="A human language."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
      </binding>
    </element>
    <element id="Observation.text">
      <path value="Observation.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition
                  value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
      <comment
               value="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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element id="Observation.contained">
      <path value="Observation.contained"/>
      <short value="Contained, inline Resources"/>
      <definition
                  value="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."/>
      <comment
               value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.extension">
      <path value="Observation.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.modifierExtension">
      <path value="Observation.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier"/>
      <short value="Business Identifier for observation"/>
      <definition value="A unique identifier assigned to this observation."/>
      <requirements
                    value="Allows observations to be distinguished and referenced."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.identifier"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.identifier"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map
             value="OBX.21  For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4."/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
    </element>
    <element id="Observation.basedOn">
      <path value="Observation.basedOn"/>
      <short value="Fulfills plan, proposal or order"/>
      <definition
                  value="A plan, proposal or order that is fulfilled in whole or in part by this event.  For example, a MedicationRequest may require a patient to have laboratory test performed before  it is dispensed."/>
      <requirements
                    value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon."/>
      <alias value="Fulfills"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.basedOn"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.basedOn"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="ORC"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.partOf">
      <path value="Observation.partOf"/>
      <short
             value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <definition
                  value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <comment
               value="To link an Observation to an Encounter use `encounter`.  See the  [Notes](observation.html#obsgrouping) below for guidance on referencing another Observation."/>
      <alias value="Container"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.partOf"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.partOf"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="Varies by domain"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=FLFS].target"/>
      </mapping>
    </element>
    <element id="Observation.status">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final"/>
      </extension>
      <path value="Observation.status"/>
      <short value="registered | preliminary | final | amended +"/>
      <definition value="The status of the result value."/>
      <comment
               value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
      <requirements
                    value="Need to track the status of individual results. Some results are finalized before the whole report is finalized."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
      <isSummary value="true"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationStatus"/>
        </extension>
        <strength value="required"/>
        <description value="Codes providing the status of an observation."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-status|4.0.0"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.status"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.status"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 445584004 |Report by finality status|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-11"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="status  Amended &amp; Final are differentiated by whether it is the subject of a ControlAct event with a type of &quot;revise&quot;"/>
      </mapping>
    </element>
    <element id="Observation.category">
      <path value="Observation.category"/>
      <short value="Classification of  type of observation"/>
      <definition
                  value="A code that classifies the general type of observation being made."/>
      <comment
               value="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."/>
      <requirements
                    value="Used for filtering what observations are retrieved and displayed."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.category"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes for high level observation categories."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.class"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
      </mapping>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
      <short value="Type of observation (code / type)"/>
      <definition
                  value="Describes what was observed. Sometimes this is called the observation &quot;name&quot;."/>
      <comment
               value="*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation."/>
      <requirements
                    value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <alias value="Name"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCode"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 363787002 |Observable entity| OR &lt; 386053000 |Evaluation procedure|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="116680003 |Is a|"/>
      </mapping>
    </element>
    <element id="Observation.code.id">
      <path value="Observation.code.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.extension">
      <path value="Observation.code.extension"/>
      <slicing>
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <description value="Extensions are always sliced by (at least) url"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="code"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="Code defined by a terminology system"/>
      <definition value="A reference to a code defined by a terminology system."/>
      <comment
               value="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."/>
      <requirements
                    value="Allows for alternative encodings within a code system, and translations to other code systems."/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="CodeableConcept.coding"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Coding"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.1-8, C*E.10-22"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="union(., ./translation)"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2">
      <path value="Observation.code.coding"/>
      <sliceName value="Fixed_21902-2"/>
      <short value="Stage group.pathology Cancer"/>
      <definition value="Stage group.pathology Cancer"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="CodeableConcept.coding"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Coding"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.id">
      <path value="Observation.code.coding.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.extension">
      <path value="Observation.code.coding.extension"/>
      <slicing>
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <description value="Extensions are always sliced by (at least) url"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.system">
      <path value="Observation.code.coding.system"/>
      <short value="Identity of the terminology system"/>
      <definition
                  value="The identification of the code system that defines the meaning of the symbol in the code."/>
      <comment
               value="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&#39;s list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously."/>
      <requirements
                    value="Need to be unambiguous about the source of the definition of the symbol."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Coding.system"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <fixedUri value="http://loinc.org"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./codeSystem"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.version">
      <path value="Observation.code.coding.version"/>
      <short value="Version of the system - if relevant"/>
      <definition
                  value="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."/>
      <comment
               value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Coding.version"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./codeSystemVersion"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.code">
      <path value="Observation.code.coding.code"/>
      <short value="Symbol in syntax defined by the system"/>
      <definition
                  value="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)."/>
      <requirements value="Need to refer to a particular code in the system."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Coding.code"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="21902-2"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./code"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.display">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/>
      </extension>
      <path value="Observation.code.coding.display"/>
      <short value="Representation defined by the system"/>
      <definition
                  value="A representation of the meaning of the code in the system, following the rules of the system."/>
      <requirements
                    value="Need to be able to carry a human-readable meaning of the code for readers that do not know  the system."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Coding.display"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.2 - but note this is not well followed"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="CV.displayName"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/>
      </mapping>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.userSelected">
      <path value="Observation.code.coding.userSelected"/>
      <short value="If this coding was chosen directly by the user"/>
      <definition
                  value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)."/>
      <comment
               value="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 &#39;directly chosen&#39; implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely."/>
      <requirements
                    value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Coding.userSelected"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Sometimes implied by being first"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="CD.codingRationale"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;     fhir:target dt:CDCoding.codingRationale\#O   ]"/>
      </mapping>
    </element>
    <element id="Observation.code.text">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/>
      </extension>
      <path value="Observation.code.text"/>
      <short value="Plain text representation of the concept"/>
      <definition
                  value="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."/>
      <comment
               value="Very often the text is the same as a displayName of one of the codings."/>
      <requirements
                    value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="CodeableConcept.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.9. But note many systems use C*E.2 for this"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/>
      </mapping>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/>
      </mapping>
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject"/>
      <short value="The subject of an observation"/>
      <definition value="The subject of an observation."/>
      <comment
               value="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."/>
      <requirements
                    value="Observations have no value if you don&#39;t know who or what they&#39;re about."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.subject"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.subject"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=RTGT]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject"/>
      </mapping>
    </element>
    <element id="Observation.focus">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="trial-use"/>
      </extension>
      <path value="Observation.focus"/>
      <short
             value="What the observation is about, when it is not about the subject of record"/>
      <definition
                  value="The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother&#39;s record.  The focus of an observation could also be an existing condition,  an intervention, the subject&#39;s diet,  another observation of the subject,  or a body structure such as tumor or implanted device.   An example use case would be using the Observation resource to capture whether the mother is trained to change her child&#39;s tracheostomy tube. In this example, the child is the patient of record and the mother is the focus."/>
      <comment
               value="Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., &quot;Blood Glucose&quot;) and does not need to be represented separately using this element.  Use `specimen` if a reference to a specimen is required.  If a code is required instead of a resource use either  `bodysite` for bodysites or the standard extension [focusCode](extension-observation-focuscode.html)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.focus"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-PrimaryCancerCondition"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SBJ]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject"/>
      </mapping>
    </element>
    <element id="Observation.encounter">
      <path value="Observation.encounter"/>
      <short value="Healthcare event during which this observation is made"/>
      <definition
                  value="The healthcare event  (e.g. a patient and healthcare provider interaction) during which this observation is made."/>
      <comment
               value="This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests)."/>
      <requirements
                    value="For some observations it may be important to know the link between an observation and a particular encounter."/>
      <alias value="Context"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.encounter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.context"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.context"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="PV1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]"/>
      <short value="Clinically relevant time/time-period for observation"/>
      <definition
                  value="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 &quot;physiologically relevant time&quot;. 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."/>
      <comment
               value="At least a date should be present unless this observation is a historical report.  For recording imprecise or &quot;fuzzy&quot; times (For example, a blood glucose measurement taken &quot;after breakfast&quot;) use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events."/>
      <requirements
                    value="Knowing when an observation was deemed true is important to its relevance as well as determining trends."/>
      <alias value="Occurrence"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.effective[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.occurrence[x]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.done[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map
             value="OBX-14, and/or OBX-19 after v2.4  (depends on who observation made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="effectiveTime"/>
      </mapping>
    </element>
    <element id="Observation.issued">
      <path value="Observation.issued"/>
      <short value="Date/Time this version was made available"/>
      <definition
                  value="The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified."/>
      <comment
               value="For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](resource-definitions.html#Meta.lastUpdated) time of the resource itself.  For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.issued"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="instant"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.recorded"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map
             value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=AUT].time"/>
      </mapping>
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer"/>
      <short value="Who is responsible for the observation"/>
      <definition
                  value="Who was responsible for asserting the observed value as &quot;true&quot;."/>
      <requirements
                    value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.performer"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.performer.actor"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.actor"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map
             value="OBX.15 / (Practitioner)  OBX-16,  PRT-5:PRT-4=&#39;RO&#39; /  (Device)  OBX-18 , PRT-10:PRT-4=&#39;EQUIP&#39; / (Organization)  OBX-23,  PRT-8:PRT-4=&#39;PO&#39;"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=PRF]"/>
      </mapping>
    </element>
    <element id="Observation.valueCodeableConcept">
      <path value="Observation.valueCodeableConcept"/>
      <short value="Actual result"/>
      <definition
                  value="The information determined as a result of making the observation, if the information has a simple value."/>
      <comment
               value="An observation may have; 1)  a single value here, 2)  both a value and a set of related or component values,  or 3)  only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code.  A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.  For additional guidance, see the [Notes section](observation.html#notes) below."/>
      <requirements
                    value="An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-7"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/onco-core-TNMStageGroupVS"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 441742003 |Evaluation finding|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363714003 |Interprets|"/>
      </mapping>
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/>
      <short value="Why the result is missing"/>
      <definition
                  value="Provides a reason why the expected value in the element Observation.value[x] is missing."/>
      <comment
               value="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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;specimen unsatisfactory&quot;.   

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 &quot;error&quot; 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 &gt; 0.  Because of these options, use-case agreements are required to interpret general observations for null or exceptional values."/>
      <requirements
                    value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-6"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes specifying why the result (`Observation.value[x]`) is missing."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element id="Observation.interpretation">
      <path value="Observation.interpretation"/>
      <short value="High, low, normal, etc."/>
      <definition
                  value="A categorical assessment of an observation value.  For example, high, low, normal."/>
      <comment
               value="Historically used for laboratory results (known as &#39;abnormal flag&#39; ),  its use extends to other use cases where coded interpretations  are relevant.  Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."/>
      <requirements
                    value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
      <alias value="Abnormal Flag"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.interpretation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363713009 |Has interpretation|"/>
      </mapping>
    </element>
    <element id="Observation.note">
      <path value="Observation.note"/>
      <short value="Comments about the observation"/>
      <definition value="Comments about the observation or the results."/>
      <comment
               value="May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation."/>
      <requirements
                    value="Need to be able to provide free text additional information."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.note"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map
             value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="subjectOf.observationEvent[code=&quot;annotation&quot;].value"/>
      </mapping>
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite"/>
      <short value="Observed body part"/>
      <definition
                  value="Indicates the site on the subject&#39;s body where the observation was made (i.e. the target site)."/>
      <comment
               value="Only used if not implicit in code found in Observation.code.  In many systems, this may be represented as a related observation instead of an inline component.   

If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](extension-bodysite.html)."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.bodySite"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-datatype-BodyLocationVS"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 123037004 |Body structure|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="718497002 |Inherent location|"/>
      </mapping>
    </element>
    <element id="Observation.method">
      <path value="Observation.method"/>
      <short value="Method or staging system used to stage the cancer"/>
      <definition value="Method or staging system used to stage the cancer."/>
      <comment value="Only used if not implicit in code for Observation.code."/>
      <requirements
                    value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.method"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/onco-core-CancerStagingSystemVS"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="methodCode"/>
      </mapping>
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen"/>
      <short value="Specimen used for this observation"/>
      <definition
                  value="The specimen that was used when this observation was made."/>
      <comment
               value="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)."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.specimen"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 123038009 |Specimen|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="SPM segment"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SPC].specimen"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="704319004 |Inherent in|"/>
      </mapping>
    </element>
    <element id="Observation.device">
      <path value="Observation.device"/>
      <short value="(Measurement) Device"/>
      <definition value="The device used to generate the observation data."/>
      <comment
               value="Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway.  Such devices may be documented using the Provenance resource where relevant."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.device"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 49062001 |Device|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17 / PRT -10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=DEV]"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="424226004 |Using device|"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/>
      <short value="Provides guide for interpretation"/>
      <definition
                  value="Guidance on how to interpret the value by comparison to a normal or recommended range.  Multiple reference ranges are interpreted as an &quot;OR&quot;.   In other words, to represent two distinct target populations, two `referenceRange` elements would be used."/>
      <comment
               value="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&#39;s age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements
                    value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="Element"/>
      </constraint>
      <constraint>
        <key value="obs-3"/>
        <severity value="error"/>
        <human value="Must have at least a low or a high or text"/>
        <expression value="low.exists() or high.exists() or text.exists()"/>
        <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.id">
      <path value="Observation.referenceRange.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.extension">
      <path value="Observation.referenceRange.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.modifierExtension">
      <path value="Observation.referenceRange.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.low">
      <path value="Observation.referenceRange.low"/>
      <short value="Low Range, if relevant"/>
      <definition
                  value="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 &gt;=5 - &lt;=9). If the low bound is omitted,  it is assumed to be meaningless (e.g. reference range is &lt;=2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.low"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.low"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.high">
      <path value="Observation.referenceRange.high"/>
      <short value="High Range, if relevant"/>
      <definition
                  value="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 &gt;=5 - &lt;=9). If the high bound is omitted,  it is assumed to be meaningless (e.g. reference range is &gt;= 2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.high"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.high"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.type">
      <path value="Observation.referenceRange.type"/>
      <short value="Reference range qualifier"/>
      <definition
                  value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range."/>
      <comment
               value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed."/>
      <requirements
                    value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc.,  - for proper interpretation."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.type"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/>
        </extension>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.appliesTo">
      <path value="Observation.referenceRange.appliesTo"/>
      <short value="Reference range population"/>
      <definition
                  value="Codes to indicate the target population this reference range applies to.  For example, a reference range may be based on the normal population or a particular sex or race.  Multiple `appliesTo`  are interpreted as an &quot;AND&quot; of the target populations.  For example, to represent a target population of African American females, both a code of female and a code for African American would be used."/>
      <comment
               value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed."/>
      <requirements
                    value="Need to be able to identify the target population for proper interpretation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange.appliesTo"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes identifying the population the reference range applies to."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.age">
      <path value="Observation.referenceRange.age"/>
      <short value="Applicable age range, if relevant"/>
      <definition
                  value="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."/>
      <requirements value="Some analytes vary greatly over age."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.age"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Range"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map
             value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.text">
      <path value="Observation.referenceRange.text"/>
      <short value="Text based reference range in an observation"/>
      <definition
                  value="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 &quot;Negative&quot; or a list or table of &quot;normals&quot;."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:ST"/>
      </mapping>
    </element>
    <element id="Observation.hasMember">
      <path value="Observation.hasMember"/>
      <slicing id="2">
        <discriminator>
          <type value="value"/>
          <path value="$this.resolve().code.coding.code"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="Related resource that belongs to the Observation group"/>
      <definition
                  value="This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group."/>
      <comment
               value="When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases.  For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below.  Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.html)  into a final score and represent the score as an Observation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.hasMember"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicPrimaryTumorCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicPrimaryTumorCategory"/>
      <short
             value="TNMPathologicPrimaryTumorCategory: Category describing the primary tumor, based on its size and extent, assessed through pathologic analysis of a tumor specimen"/>
      <definition
                  value="Category describing the primary tumor, based on its size and extent, assessed through pathologic analysis of a tumor specimen."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.hasMember"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicPrimaryTumorCategory"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicRegionalNodesCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicRegionalNodesCategory"/>
      <short
             value="TNMPathologicRegionalNodesCategory: Category describing the presence or absence of metastases in regional lymph nodes, assessed through pathologic analysis of a specimen"/>
      <definition
                  value="Category describing the presence or absence of metastases in regional lymph nodes, assessed through pathologic analysis of a specimen."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.hasMember"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicRegionalNodesCategory"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicDistantMetastasesCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicDistantMetastasesCategory"/>
      <short
             value="TNMPathologicDistantMetastasesCategory: Category describing the presence or absence of metastases in remote anatomical locations, assessed through pathologic analysis of a specimen"/>
      <definition
                  value="Category describing the presence or absence of metastases in remote anatomical locations, assessed through pathologic analysis of a specimen."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.hasMember"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicDistantMetastasesCategory"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship"/>
      </mapping>
    </element>
    <element id="Observation.derivedFrom">
      <path value="Observation.derivedFrom"/>
      <short value="Related measurements the observation is made from"/>
      <definition
                  value="The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image."/>
      <comment
               value="All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value.  The most common reference will be another Observation.  For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.derivedFrom"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Media"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="Relationships established by OBX-4 usage"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="Observation.component">
      <path value="Observation.component"/>
      <short value="Component results"/>
      <definition
                  value="Some observations have multiple component observations.  These component observations are expressed as separate code value pairs that share the same attributes.  Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations."/>
      <comment
               value="For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below."/>
      <requirements
                    value="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."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.component"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="containment by OBX-4?"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="outBoundRelationship[typeCode=COMP]"/>
      </mapping>
    </element>
    <element id="Observation.component.id">
      <path value="Observation.component.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.extension">
      <path value="Observation.component.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.modifierExtension">
      <path value="Observation.component.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.component.code">
      <path value="Observation.component.code"/>
      <short value="Type of component observation (code / type)"/>
      <definition
                  value="Describes what was observed. Sometimes this is called the observation &quot;code&quot;."/>
      <comment
               value="*All* code-value and  component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation."/>
      <requirements
                    value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.code"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCode"/>
        </extension>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes"/>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 363787002 |Observable entity| OR 
&lt; 386053000 |Evaluation procedure|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
    </element>
    <element id="Observation.component.value[x]">
      <path value="Observation.component.value[x]"/>
      <short value="Actual component result"/>
      <definition
                  value="The information determined as a result of making the observation, if the information has a simple value."/>
      <comment
               value="Used when observation has a set of component observations. An observation may have both a value (e.g. an  Apgar score)  and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.  For additional guidance, see the [Notes section](observation.html#notes) below."/>
      <requirements
                    value="An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="sct-concept"/>
        <map value="363714003 |Interprets| &lt; 441742003 |Evaluation finding|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363714003 |Interprets|"/>
      </mapping>
    </element>
    <element id="Observation.component.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason"/>
      <short value="Why the component result is missing"/>
      <definition
                  value="Provides a reason why the expected value in the element Observation.component.value[x] is missing."/>
      <comment
               value="&quot;Null&quot; 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  &quot;detected&quot;, &quot;not detected&quot;, &quot;inconclusive&quot;, or  &quot;test not done&quot;. 

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 &quot;error&quot; 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."/>
      <requirements
                    value="For many results it is necessary to handle exceptional values in measurements."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.component.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="obs-6"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationValueAbsentReason"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes specifying why the result (`Observation.value[x]`) is missing."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element id="Observation.component.interpretation">
      <path value="Observation.component.interpretation"/>
      <short value="High, low, normal, etc."/>
      <definition
                  value="A categorical assessment of an observation value.  For example, high, low, normal."/>
      <comment
               value="Historically used for laboratory results (known as &#39;abnormal flag&#39; ),  its use extends to other use cases where coded interpretations  are relevant.  Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."/>
      <requirements
                    value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result."/>
      <alias value="Abnormal Flag"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.interpretation"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationInterpretation"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map value="&lt; 260245000 |Findings values|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
      <mapping>
        <identity value="sct-attr"/>
        <map value="363713009 |Has interpretation|"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/>
      <short value="Provides guide for interpretation of component result"/>
      <definition
                  value="Guidance on how to interpret the value by comparison to a normal or recommended range."/>
      <comment
               value="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&#39;s age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <requirements
                    value="Knowing what values are considered &quot;normal&quot; can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.component.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.id">
      <path value="Observation.component.referenceRange.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.extension">
      <path value="Observation.component.referenceRange.extension"/>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.modifierExtension">
      <path value="Observation.component.referenceRange.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.low">
      <path value="Observation.component.referenceRange.low"/>
      <short value="Low Range, if relevant"/>
      <definition
                  value="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 &gt;=5 - &lt;=9). If the low bound is omitted,  it is assumed to be meaningless (e.g. reference range is &lt;=2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.low"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.low"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.high">
      <path value="Observation.component.referenceRange.high"/>
      <short value="High Range, if relevant"/>
      <definition
                  value="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 &gt;=5 - &lt;=9). If the high bound is omitted,  it is assumed to be meaningless (e.g. reference range is &gt;= 2.3)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.high"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <condition value="obs-3"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:IVL_PQ.high"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.type">
      <path value="Observation.component.referenceRange.type"/>
      <short value="Reference range qualifier"/>
      <definition
                  value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range."/>
      <comment
               value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal range is assumed."/>
      <requirements
                    value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc.,  - for proper interpretation."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.type"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/>
        </extension>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.appliesTo">
      <path value="Observation.component.referenceRange.appliesTo"/>
      <short value="Reference range population"/>
      <definition
                  value="Codes to indicate the target population this reference range applies to.  For example, a reference range may be based on the normal population or a particular sex or race.  Multiple `appliesTo`  are interpreted as an &quot;AND&quot; of the target populations.  For example, to represent a target population of African American females, both a code of female and a code for African American would be used."/>
      <comment
               value="This SHOULD be populated if there is more than one range.  If this element is not present then the normal population is assumed."/>
      <requirements
                    value="Need to be able to identify the target population for proper interpretation."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.referenceRange.appliesTo"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes identifying the population the reference range applies to."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
      </binding>
      <mapping>
        <identity value="sct-concept"/>
        <map
             value="&lt; 260245000 |Findings values| OR  
&lt; 365860008 |General clinical state finding| 
OR 
&lt; 250171008 |Clinical history or observation findings| OR  
&lt; 415229000 |Racial group| OR 
&lt; 365400002 |Finding of puberty stage| OR
&lt; 443938003 |Procedure carried out on subject|"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.age">
      <path value="Observation.component.referenceRange.age"/>
      <short value="Applicable age range, if relevant"/>
      <definition
                  value="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."/>
      <requirements value="Some analytes vary greatly over age."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.age"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Range"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map
             value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=&quot;age&quot;].value"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.text">
      <path value="Observation.component.referenceRange.text"/>
      <short value="Text based reference range in an observation"/>
      <definition
                  value="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 &quot;Negative&quot; or a list or table of &quot;normals&quot;."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.referenceRange.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value:ST"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element id="Observation">
      <path value="Observation"/>
      <short value="onco-core-TNMPathologicStageGroup"/>
      <definition
                  value="The extent of the cancer in the body, according to the TNM classification system, based on examination of tissue samples removed during surgery, in addition to physical examination and imaging and potentially, other prognostic factors."/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.basedOn">
      <path value="Observation.basedOn"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      </type>
    </element>
    <element id="Observation.partOf">
      <path value="Observation.partOf"/>
      <short
             value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <definition
                  value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
      </type>
    </element>
    <element id="Observation.category">
      <path value="Observation.category"/>
      <min value="0"/>
      <max value="1"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationCategory"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes for high level observation categories."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-category"/>
      </binding>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="code"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="1"/>
      <max value="*"/>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2">
      <path value="Observation.code.coding"/>
      <sliceName value="Fixed_21902-2"/>
      <short value="Stage group.pathology Cancer"/>
      <definition value="Stage group.pathology Cancer"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="CodeableConcept.coding"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Coding"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.system">
      <path value="Observation.code.coding.system"/>
      <fixedUri value="http://loinc.org"/>
    </element>
    <element id="Observation.code.coding:Fixed_21902-2.code">
      <path value="Observation.code.coding.code"/>
      <fixedCode value="21902-2"/>
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject"/>
      <short value="The subject of an observation"/>
      <definition value="The subject of an observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
    </element>
    <element id="Observation.focus">
      <path value="Observation.focus"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-PrimaryCancerCondition"/>
      </type>
    </element>
    <element id="Observation.encounter">
      <path value="Observation.encounter"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
      </type>
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]"/>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
      </type>
    </element>
    <element id="Observation.valueCodeableConcept">
      <path value="Observation.valueCodeableConcept"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/onco-core-TNMStageGroupVS"/>
      </binding>
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/>
      <min value="0"/>
      <max value="0"/>
    </element>
    <element id="Observation.interpretation">
      <path value="Observation.interpretation"/>
      <min value="0"/>
      <max value="1"/>
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite"/>
      <min value="0"/>
      <max value="0"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-datatype-BodyLocationVS"/>
      </binding>
    </element>
    <element id="Observation.method">
      <path value="Observation.method"/>
      <short value="Method or staging system used to stage the cancer"/>
      <definition value="Method or staging system used to stage the cancer."/>
      <mustSupport value="true"/>
      <binding>
        <strength value="extensible"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/onco-core-CancerStagingSystemVS"/>
      </binding>
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen"/>
      <min value="0"/>
      <max value="0"/>
    </element>
    <element id="Observation.device">
      <path value="Observation.device"/>
      <min value="0"/>
      <max value="0"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
      </type>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/>
      <min value="0"/>
      <max value="0"/>
    </element>
    <element id="Observation.referenceRange.type">
      <path value="Observation.referenceRange.type"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/>
        </extension>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
      </binding>
    </element>
    <element id="Observation.referenceRange.appliesTo">
      <path value="Observation.referenceRange.appliesTo"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes identifying the population the reference range applies to."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
      </binding>
    </element>
    <element id="Observation.hasMember">
      <path value="Observation.hasMember"/>
      <slicing id="2">
        <discriminator>
          <type value="value"/>
          <path value="$this.resolve().code.coding.code"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicPrimaryTumorCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicPrimaryTumorCategory"/>
      <short
             value="TNMPathologicPrimaryTumorCategory: Category describing the primary tumor, based on its size and extent, assessed through pathologic analysis of a tumor specimen"/>
      <definition
                  value="Category describing the primary tumor, based on its size and extent, assessed through pathologic analysis of a tumor specimen."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicPrimaryTumorCategory"/>
      </type>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicRegionalNodesCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicRegionalNodesCategory"/>
      <short
             value="TNMPathologicRegionalNodesCategory: Category describing the presence or absence of metastases in regional lymph nodes, assessed through pathologic analysis of a specimen"/>
      <definition
                  value="Category describing the presence or absence of metastases in regional lymph nodes, assessed through pathologic analysis of a specimen."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicRegionalNodesCategory"/>
      </type>
    </element>
    <element
             id="Observation.hasMember:onco-core-TNMPathologicDistantMetastasesCategory">
      <path value="Observation.hasMember"/>
      <sliceName value="onco-core-TNMPathologicDistantMetastasesCategory"/>
      <short
             value="TNMPathologicDistantMetastasesCategory: Category describing the presence or absence of metastases in remote anatomical locations, assessed through pathologic analysis of a specimen"/>
      <definition
                  value="Category describing the presence or absence of metastases in remote anatomical locations, assessed through pathologic analysis of a specimen."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/onco-core-TNMPathologicDistantMetastasesCategory"/>
      </type>
    </element>
    <element id="Observation.derivedFrom">
      <path value="Observation.derivedFrom"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Media"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
    </element>
    <element id="Observation.component">
      <path value="Observation.component"/>
      <min value="0"/>
      <max value="0"/>
    </element>
    <element id="Observation.component.value[x]">
      <path value="Observation.component.value[x]"/>
      <type>
        <code value="Quantity"/>
      </type>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="string"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="SampledData"/>
      </type>
      <type>
        <code value="time"/>
      </type>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
    </element>
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/>
    </element>
    <element id="Observation.component.referenceRange.type">
      <path value="Observation.component.referenceRange.type"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeMeaning"/>
        </extension>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
      </binding>
    </element>
    <element id="Observation.component.referenceRange.appliesTo">
      <path value="Observation.component.referenceRange.appliesTo"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ObservationRangeType"/>
        </extension>
        <strength value="extensible"/>
        <description
                     value="Codes identifying the population the reference range applies to."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-appliesto"/>
      </binding>
    </element>
  </differential>
</StructureDefinition>