HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE), v0.9.1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE), v0.9.1 FHIR Profiles - Local Development build (v0.9.1). See the Directory of published versions

TNMClinicalStageGroup


<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="onco-core-TNMClinicalStageGroup"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
  <p><b>TNMClinicalStageGroup Profile</b></p>
  <p>The extent of the cancer in the body, according to the TNM classification system, based on information obtained prior to neoadjuvant treatment and surgery, e.g. based on evidence such as physical examination, imaging, and/or biopsy.</p>
  <p><b>Mapping Summary</b></p>
  <p><pre>onco.core.TNMClinicalStageGroup maps to Observation:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.extension
  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 extension
  ObservationPartOf maps to extension
  Status maps to status
  Category maps to category
  Code maps to code
  ObservationSubjectOfRecord maps to subject
  FocalSubject maps to modifierExtension
  CareContext maps to encounter
  RelevantTime maps to effective[x]
  StatementDateTime maps to issued
  Performer maps to performer
  DataValue maps to value[x]
  DataAbsentReason maps to dataAbsentReason
  Interpretation maps to interpretation
  Annotation maps to extension
  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.meaning
  ReferenceRange.ApplicableSubpopulation maps to referenceRange.extension
  ReferenceRange.ApplicableAgeRange maps to referenceRange.age
  ReferenceRange.Text maps to referenceRange.text
  fix related.type to #has-member
  PanelMembers maps to related
  PanelMembers.Observation maps to related.target (slice at = related; slice on = target.reference.resolve(); slice on type = profile; slice strategy = includes)
  ObservationDerivedFrom maps to extension
  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.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.meaning
  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://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalStageGroup"/>
  <version value="0.9.1"/>
  <name value="TNMClinicalStageGroup"/>
  <display value="onco-core-TNMClinicalStageGroup"/>
  <status value="draft"/>
  <publisher value="The MITRE Corporation"/>
  <contact>
    <telecom>
      <system value="other"/>
      <value value="http://standardhealthrecord.org"/>
      <rank value="0"/>
    </telecom>
  </contact>
  <date value="2019-10-23T00:00:00-04:00"/>
  <description
               value="The extent of the cancer in the body, according to the TNM classification system, based on information obtained prior to neoadjuvant treatment and surgery, e.g. based on evidence such as physical examination, imaging, and/or biopsy."/>
  <requirements
                value="Observations are a key aspect of healthcare.  This resource is used to capture those that do not require more sophisticated mechanisms."/>
  <fhirVersion value="1.0.2"/>
  <mapping>
    <identity value="v2"/>
    <uri value="http://hl7.org/v2"/>
    <name value="HL7 v2"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM"/>
  </mapping>
  <mapping>
    <identity value="w5"/>
    <uri value="http://hl7.org/fhir/w5"/>
    <name value="W5 Mapping"/>
  </mapping>
  <kind value="resource"/>
  <constrainedType value="Observation"/>
  <abstract value="false"/>
  <base value="http://hl7.org/fhir/StructureDefinition/Observation"/>
  <snapshot>
    <element id="Observation">
      <path value="Observation"/>
      <name value="Observation"/>
      <short value="onco-core-TNMClinicalStageGroup"/>
      <definition
                  value="The extent of the cancer in the body, according to the TNM classification system, based on information obtained prior to neoadjuvant treatment and surgery, e.g. based on evidence such as physical examination, imaging, and/or biopsy."/>
      <comments
                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 lab reports, etc."/>
      <alias value="Vital Signs"/>
      <alias value="Measurement"/>
      <alias value="Results"/>
      <alias value="Tests"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Observation"/>
      </type>
      <maxLength value="0"/>
      <constraint>
        <key value="obs-6"/>
        <severity value="error"/>
        <human
               value="SHALL only be present if Observation.value[x] is not present"/>
        <xpath
               value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), &#39;value&#39;)])))"/>
      </constraint>
      <constraint>
        <key value="obs-7"/>
        <severity value="error"/>
        <human value="Component code SHALL not be same as observation code"/>
        <xpath
               value="not(exists(f:component/f:code)) or count(for $coding in f:code/f:coding return parent::*/f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value and f:system/@value=$coding/f:system/@value])=0"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Observation[classCode=OBS, moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="clinical.diagnostics"/>
      </mapping>
    </element>
    <element id="Observation.id">
      <path value="Observation.id"/>
      <name 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."/>
      <comments
                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. Bundles always have an id, though it is usually a generated UUID."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta">
      <path value="Observation.meta"/>
      <name 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 may not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Meta"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta.id">
      <path value="Observation.meta.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.meta.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.meta.extension">
      <path value="Observation.meta.extension"/>
      <name value="Observation.meta.extension"/>
      <slicing id="3">
        <discriminator value="url"/>
        <ordered value="false"/>
        <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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="sourcesystem">
      <path value="Observation.meta.extension"/>
      <name value="sourcesystem"/>
      <definition
                  value="FHIR: This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
FHIM: Identifies the computer system that created the medical record. This optional field may also be used to indicate that the medical record was originally created by a different organization from the one that is currently storing or utilizing the record in that the assigning authority of the Id could be set to that originating organization. This property is optional, as some systems will assume that all records that it contains originated in that system, however it is anticipated that it will become increasingly commonplace for records from multiple systems and organizations will be comingled in order to provide a complete picture of the patient&#39;s health record."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.meta.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SourceSystem-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.meta.versionId">
      <path value="Observation.meta.versionId"/>
      <name value="Observation.meta.versionId"/>
      <short value="Version specific identifier"/>
      <definition
                  value="The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted."/>
      <comments
                value="The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta.lastUpdated">
      <path value="Observation.meta.lastUpdated"/>
      <name value="Observation.meta.lastUpdated"/>
      <short value="When the resource version last changed"/>
      <definition
                  value="When the resource last changed - e.g. when the version changed."/>
      <comments
                value="This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="instant"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta.profile">
      <path value="Observation.meta.profile"/>
      <name value="Observation.meta.profile"/>
      <short value="Profiles this resource claims to conform to"/>
      <definition
                  value="A list of profiles [[[StructureDefinition]]]s that this resource claims to conform to. The URL is a reference to [[[StructureDefinition.url]]]."/>
      <comments
                value="It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time.  The list of profile URLs is a set."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="uri"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.meta.security">
      <path value="Observation.meta.security"/>
      <name value="Observation.meta.security"/>
      <short value="Security Labels applied to this resource"/>
      <definition
                  value="Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure."/>
      <comments
                value="The security labels can be updated without changing the stated version of the resource  The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Coding"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="extensible"/>
        <description
                     value="Security Labels from the Healthcare Privacy and Security Classification System."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/security-labels"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.meta.tag">
      <path value="Observation.meta.tag"/>
      <name value="Observation.meta.tag"/>
      <short value="Tags applied to this resource"/>
      <definition
                  value="Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource."/>
      <comments
                value="The tags can be updated without changing the stated version of the resource.  The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Coding"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description
                     value="Codes that represent various types of tags, commonly workflow-related; e.g. &quot;Needs review by Dr. Jones&quot;"/>
      </binding>
    </element>
    <element id="Observation.implicitRules">
      <path value="Observation.implicitRules"/>
      <name 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."/>
      <comments
                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 as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="uri"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.language">
      <path value="Observation.language"/>
      <name value="Observation.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments
                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"/>
      <type>
        <code value="code"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <description value="A human language."/>
        <valueSetReference>
          <reference value="http://tools.ietf.org/html/bcp47"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.text">
      <path value="Observation.text"/>
      <name 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 may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &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."/>
      <comments
                value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Narrative"/>
      </type>
      <maxLength value="0"/>
      <condition value="dom-1"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element id="Observation.contained">
      <path value="Observation.contained"/>
      <name 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."/>
      <comments
                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."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Resource"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.extension">
      <path value="Observation.extension"/>
      <name value="Observation.extension"/>
      <slicing id="2">
        <discriminator value="url"/>
        <ordered value="false"/>
        <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 resource. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="observationbasedon">
      <path value="Observation.extension"/>
      <name value="observationbasedon"/>
      <definition
                  value="The 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."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationBasedOn-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="observationpartof">
      <path value="Observation.extension"/>
      <name value="observationpartof"/>
      <definition
                  value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationPartOf-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="annotation">
      <path value="Observation.extension"/>
      <name value="annotation"/>
      <definition
                  value="An added or follow-up note, often after the fact, that contains metadata about who made the statement and when."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Annotation-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="observationderivedfrom">
      <path value="Observation.extension"/>
      <name value="observationderivedfrom"/>
      <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."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationDerivedFrom-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.modifierExtension">
      <path value="Observation.modifierExtension"/>
      <name value="Observation.modifierExtension"/>
      <slicing id="4">
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="focalsubject">
      <path value="Observation.modifierExtension"/>
      <name value="focalsubject"/>
      <definition
                  value="The person or entity that the information in this resource relates to, if different than the person of record. The subject of information can be a reference or a code, the latter when the subject is described generically, for example, in terms of a relationship to the subject of record (e.g., wife)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-FocalSubject-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.modifierExtension-focalsubject.id">
      <path value="Observation.modifierExtension.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.modifierExtension-focalsubject.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.modifierExtension-focalsubject.extension">
      <path value="Observation.modifierExtension.extension"/>
      <name value="Observation.modifierExtension-focalsubject.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="0"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.modifierExtension-focalsubject.url">
      <path value="Observation.modifierExtension.url"/>
      <representation value="xmlAttr"/>
      <name value="Observation.modifierExtension-focalsubject.url"/>
      <short value="identifies the meaning of the extension"/>
      <definition
                  value="Source of the definition for the extension code - a logical name or a URL."/>
      <comments
                value="The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific.  This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Extension.url"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <fixedUri
                value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-FocalSubject-extension"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.modifierExtension-focalsubject.valueReference">
      <path value="Observation.modifierExtension.valueReference"/>
      <name value="Observation.modifierExtension-focalsubject.valueReference"/>
      <short
             value="PrimaryCancerCondition: Records the history of the primary cancer condition, the original or first tumor in the body (reference https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-tumor)"/>
      <definition
                  value="Records the history of the primary cancer condition, the original or first tumor in the body (reference https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-tumor). Cancers that are not clearly secondary (i.e., of uncertain origin or behavior) should be documented as primary.

Cancer staging information summarized in this profile should reflect the most recent staging assessment on the patient, and should be updated if and when there is a new staging assessment. Past staging assessments will be preserved in instances of the TNMClinicalStageGroup and/or TNMPathologicalStageGroup, which refer back to PrimaryCancerCondition.

Conformance note: For the code attribute, to be compliant with [US Core Profiles](http://hl7.org/fhir/us/core/STU3/index.html), SNOMED CT must be used unless there is no suitable code, in which case ICD-10-CM can be used."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Extension.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-PrimaryCancerCondition"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier"/>
      <name value="Observation.identifier"/>
      <short value="Unique Id for this particular observation"/>
      <definition
                  value="A unique identifier for the simple observation instance."/>
      <requirements
                    value="Allows observations to be distinguished and referenced."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Identifier"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.21"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="id"/>
      </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"/>
      <name value="Observation.status"/>
      <short value="registered | preliminary | final | amended +"/>
      <definition value="The status of the result value."/>
      <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"/>
      <type>
        <code value="code"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Codes providing the status of an observation."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-status"/>
        </valueSetReference>
      </binding>
      <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>
      <mapping>
        <identity value="w5"/>
        <map value="status"/>
      </mapping>
    </element>
    <element id="Observation.category">
      <path value="Observation.category"/>
      <name value="Observation.category"/>
      <short value="Classification of  type of observation"/>
      <definition
                  value="A code that classifies the general type of observation being made.  This is used  for searching, sorting and display purposes."/>
      <comments
                value="The level of granularity is defined by the category concepts in the value set.   More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in Observation.code."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Codes for high level observation categories ."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-category"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="class"/>
      </mapping>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
      <name 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;."/>
      <requirements
                    value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="what"/>
      </mapping>
    </element>
    <element id="Observation.code.id">
      <path value="Observation.code.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.code.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.code.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.code.coding"/>
      <slicing id="1">
        <discriminator value="code"/>
        <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."/>
      <comments
                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 labelled as UserSelected = true."/>
      <requirements
                    value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings."/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="Coding"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.1-8, C*E.10-22"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="union(., ./translation)"/>
      </mapping>
    </element>
    <element id="Fixed_21908-9">
      <path value="Observation.code.coding"/>
      <name value="Fixed_21908-9"/>
      <short value="Stage group.clinical Cancer"/>
      <definition value="Stage group.clinical Cancer"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.id">
      <path value="Observation.code.coding.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.code.coding-Fixed-21908-9.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.extension">
      <path value="Observation.code.coding.extension"/>
      <name value="Observation.code.coding-Fixed-21908-9.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.system">
      <path value="Observation.code.coding.system"/>
      <name value="Observation.code.coding-Fixed-21908-9.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."/>
      <comments
                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 de-reference to some definition that establish 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"/>
      <type>
        <code value="uri"/>
      </type>
      <fixedUri value="http://loinc.org"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./codeSystem"/>
      </mapping>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.version">
      <path value="Observation.code.coding.version"/>
      <name value="Observation.code.coding-Fixed-21908-9.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."/>
      <comments
                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"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./codeSystemVersion"/>
      </mapping>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.code">
      <path value="Observation.code.coding.code"/>
      <name value="Observation.code.coding-Fixed-21908-9.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"/>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="21908-9"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="C*E.1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="./code"/>
      </mapping>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.display">
      <path value="Observation.code.coding.display"/>
      <name value="Observation.code.coding-Fixed-21908-9.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"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/>
      </mapping>
      <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>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.userSelected">
      <path value="Observation.code.coding.userSelected"/>
      <name value="Observation.code.coding-Fixed-21908-9.userSelected"/>
      <short value="If this coding was chosen directly by the user"/>
      <definition
                  value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)."/>
      <comments
                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"/>
      <type>
        <code value="boolean"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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>
      <mapping>
        <identity value="v2"/>
        <map value="Sometimes implied by being first"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="CD.codingRationale"/>
      </mapping>
    </element>
    <element id="Observation.code.text">
      <path value="Observation.code.text"/>
      <name 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."/>
      <comments
                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"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="orim"/>
        <map
             value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/>
      </mapping>
      <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>
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject"/>
      <name value="Observation.subject"/>
      <short value="The subject of an observation"/>
      <definition value="The subject of an observation."/>
      <comments
                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.

If the target of the observation is different than the subject, the general extension [observation-focal-subject](extension-observation-focal-subject.html).  may be used.  However, the distinction between the patient&#39;s own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code."/>
      <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"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SBJ]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.focus"/>
      </mapping>
    </element>
    <element id="Observation.encounter">
      <path value="Observation.encounter"/>
      <name 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."/>
      <requirements
                    value="For some observations it may be important to know the link between an observation and a particular encounter."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="PV1"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="context"/>
      </mapping>
    </element>
    <element id="Observation.effectivex">
      <path value="Observation.effective[x]"/>
      <name value="Observation.effectivex"/>
      <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."/>
      <comments
                value="At least a date should be present unless this observation is a historical report."/>
      <requirements
                    value="Knowing when an observation was deemed true is important to its relevance as well as determining trends."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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>
      <mapping>
        <identity value="w5"/>
        <map value="when.done"/>
      </mapping>
    </element>
    <element id="Observation.issued">
      <path value="Observation.issued"/>
      <name value="Observation.issued"/>
      <short value="Date/Time this was made available"/>
      <definition
                  value="The date and time this observation was made available to providers, typically after the results have been reviewed and verified."/>
      <comments value="Updated when the result is updated."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="instant"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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>
      <mapping>
        <identity value="w5"/>
        <map value="when.recorded"/>
      </mapping>
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer"/>
      <name 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="*"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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>
      <mapping>
        <identity value="w5"/>
        <map value="who.actor"/>
      </mapping>
    </element>
    <element id="Observation.valueCodeableConcept">
      <path value="Observation.valueCodeableConcept"/>
      <name 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."/>
      <comments
                value="Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is &quot;&#39;value&#39; + the type name&quot; with a capital on the first letter of the type).


If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text.  A value set is bound to the ValueCodeableConcept element.  For boolean values use valueCodeableConcept and select codes from [HL7 Version 2 Table 0136](v2/0136/index.html). These &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot; or other mutually exclusive terms that may be needed.   For further discussion and examples see the  [notes section](observation.html#4.20.4) below."/>
      <requirements
                    value="An observation exists to have a value, though it may not if it is in error, or 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>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference
                     value="http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-TNMStageGroupVS"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/>
      <name 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."/>
      <comments
                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.  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="0"/>
      <base>
        <path value="Observation.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-6"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description
                     value="Codes specifying why the result (Observation.value[x]) is missing."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
        </valueSetReference>
      </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"/>
      <name value="Observation.interpretation"/>
      <short value="High, low, normal, etc."/>
      <definition
                  value="The assessment made based on the result of the observation.  Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag."/>
      <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"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Codes identifying interpretations of observations."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-interpretation"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-8"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="interpretationCode"/>
      </mapping>
    </element>
    <element id="Observation.comments">
      <path value="Observation.comments"/>
      <name value="Observation.comments"/>
      <short value="Comments about result"/>
      <definition
                  value="May include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result."/>
      <requirements
                    value="Need to be able to provide free text additional information."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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)."/>
      <comments
                value="Only used if not implicit in code found in Observation.code.  If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension[ body-site-instance](extension-body-site-instance.html)."/>
      <requirements
                    value="Knowing where the observation is made is important for tracking if multiple sites are possible."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.bodySite"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="preferred"/>
        <description
                     value="Codes describing anatomical locations. May include laterality."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/body-site"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="targetSiteCode"/>
      </mapping>
    </element>
    <element id="Observation.method">
      <path value="Observation.method"/>
      <name 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."/>
      <comments 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"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <valueSetReference>
          <reference
                     value="http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-CancerStagingSystemVS"/>
        </valueSetReference>
      </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"/>
      <name value="Observation.specimen"/>
      <short value="Specimen used for this observation"/>
      <definition
                  value="The specimen that was used when this observation was made."/>
      <comments
                value="Observations are not made on specimens themselves; they are made on a subject, but usually 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"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Specimen"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="SPM segment"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=SPC].specimen"/>
      </mapping>
    </element>
    <element id="Observation.device">
      <path value="Observation.device"/>
      <name value="Observation.device"/>
      <short value="(Measurement) Device"/>
      <definition value="The device used to generate the observation data."/>
      <comments
                value="An extension should be used if further typing of the device is needed.  Devices used to support obtaining an observation can be represented using either extension or through the Observation.related element."/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.device"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://fhir.org/guides/argonaut/StructureDefinition/argo-device"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-17 / PRT -10"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=DEV]"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/>
      <name 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."/>
      <comments
                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 may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <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>
      <maxLength value="0"/>
      <constraint>
        <key value="obs-3"/>
        <severity value="error"/>
        <human value="Must have at least a low or a high or text"/>
        <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))"/>
      </constraint>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.referenceRange.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.referenceRange.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.referenceRange.low">
      <path value="Observation.referenceRange.low"/>
      <name 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"/>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-3"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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"/>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-3"/>
      <mustSupport value="false"/>
      <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.meaning">
      <path value="Observation.referenceRange.meaning"/>
      <name value="Observation.referenceRange.meaning"/>
      <short value="Indicates the meaning/use of this range of this range"/>
      <definition value="Code for the meaning of the reference range."/>
      <comments
                value="This SHOULD be populated if there is more than one range."/>
      <requirements
                    value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, or perhaps what state this reference range applies to (i.e. age, hormonal cycles, etc.)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
        </valueSetReference>
      </binding>
      <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"/>
      <name 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"/>
      <type>
        <code value="Range"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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 &#39;normals&#39;."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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.related">
      <path value="Observation.related"/>
      <name value="Observation.related"/>
      <slicing id="5">
        <discriminator value="target.reference/@profile"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="Resource related to this observation"/>
      <definition
                  value="A  reference to another resource (usually another Observation but could  also be a QuestionnaireAnswer) whose relationship is defined by the relationship type code."/>
      <comments
                value="For a discussion on the ways Observations can assembled in groups together see [Notes below](observation.html#4.20.4)."/>
      <requirements
                    value="Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes QuestionnaireResponse  from which the measure is derived."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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.related.id">
      <path value="Observation.related.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.related.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related.extension">
      <path value="Observation.related.extension"/>
      <name value="Observation.related.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related.modifierExtension">
      <path value="Observation.related.modifierExtension"/>
      <name value="Observation.related.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.related.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related.type"/>
      <short
             value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
      <definition
                  value="A code specifying the kind of relationship that exists with the target resource."/>
      <comments
                value="&quot;derived-from&quot; is only logical choice when referencing QuestionnaireAnswer resource."/>
      <requirements value="A relationship type SHOULD be provided."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <description value="Codes specifying how two observations are related."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element id="Observation.related.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related.target"/>
      <short value="Resource that is related to this one"/>
      <definition
                  value="A reference to the observation or [[[QuestionnaireResponse]]] resource that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="onco-core-TNMClinicalPrimaryTumorCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalPrimaryTumorCategory"/>
      <short
             value="TNMClinicalPrimaryTumorCategory: Category of the primary tumor, based on its size and extent, assessed prior to surgery, based on evidence such as physical examination, imaging, and/or biopsy"/>
      <definition
                  value="Category of the primary tumor, based on its size and extent, assessed prior to surgery, based on evidence such as physical examination, imaging, and/or biopsy."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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.related-TNMClinicalPrimaryTumorCategory.id">
      <path value="Observation.related.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.extension">
      <path value="Observation.related.extension"/>
      <name
            value="Observation.related-TNMClinicalPrimaryTumorCategory.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.mod">
      <path value="Observation.related.modifierExtension"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.mod"/>
      <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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.type"/>
      <short
             value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
      <definition
                  value="A code specifying the kind of relationship that exists with the target resource."/>
      <comments
                value="&quot;derived-from&quot; is only logical choice when referencing QuestionnaireAnswer resource."/>
      <requirements value="A relationship type SHOULD be provided."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <description value="Codes specifying how two observations are related."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.target"/>
      <short value="Resource that is related to this one"/>
      <definition
                  value="A reference to the observation or [[[QuestionnaireResponse]]] resource that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalPrimaryTumorCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="onco-core-TNMClinicalRegionalNodesCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalRegionalNodesCategory"/>
      <short
             value="TNMClinicalRegionalNodesCategory: Category of the presence or absence of metastases in regional lymph nodes, assessed using tests that are done before surgery"/>
      <definition
                  value="Category of the presence or absence of metastases in regional lymph nodes, assessed using tests that are done before surgery. These include physical exams, imaging tests, laboratory tests (such as blood tests), and biopsies (definition adapted from NCI Dictionary of Cancer Terms)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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.related-TNMClinicalRegionalNodesCategory.id">
      <path value="Observation.related.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.extension">
      <path value="Observation.related.extension"/>
      <name
            value="Observation.related-TNMClinicalRegionalNodesCategory.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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.mod">
      <path value="Observation.related.modifierExtension"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.mod"/>
      <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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.type"/>
      <short
             value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
      <definition
                  value="A code specifying the kind of relationship that exists with the target resource."/>
      <comments
                value="&quot;derived-from&quot; is only logical choice when referencing QuestionnaireAnswer resource."/>
      <requirements value="A relationship type SHOULD be provided."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <description value="Codes specifying how two observations are related."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.target"/>
      <short value="Resource that is related to this one"/>
      <definition
                  value="A reference to the observation or [[[QuestionnaireResponse]]] resource that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalRegionalNodesCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="onco-core-TNMClinicalDistantMetastasesCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalDistantMetastasesCategory"/>
      <short
             value="TNMClinicalDistantMetastasesCategory: Category describing the presence or absence of metastases in remote anatomical locations, assessed using tests that are done before surgery"/>
      <definition
                  value="Category describing the presence or absence of metastases in remote anatomical locations, assessed using tests that are done before surgery. These include physical exams, imaging tests, laboratory tests (such as blood tests), and biopsies (definition adapted from NCI Dictionary of Cancer Terms)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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.related-TNMClinicalDistantMetastasesCategory.id">
      <path value="Observation.related.id"/>
      <representation value="xmlAttr"/>
      <name value="Observation.related-TNMClinicalDistantMetastasesCategory.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalDistantMetastasesCategory.ext">
      <path value="Observation.related.extension"/>
      <name value="Observation.related-TNMClinicalDistantMetastasesCategory.ext"/>
      <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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalDistantMetastasesCategory.mod">
      <path value="Observation.related.modifierExtension"/>
      <name value="Observation.related-TNMClinicalDistantMetastasesCategory.mod"/>
      <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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.related-TNMClinicalDistantMetastasesCategory.type">
      <path value="Observation.related.type"/>
      <name
            value="Observation.related-TNMClinicalDistantMetastasesCategory.type"/>
      <short
             value="has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by"/>
      <definition
                  value="A code specifying the kind of relationship that exists with the target resource."/>
      <comments
                value="&quot;derived-from&quot; is only logical choice when referencing QuestionnaireAnswer resource."/>
      <requirements value="A relationship type SHOULD be provided."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <description value="Codes specifying how two observations are related."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-relationshiptypes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".typeCode"/>
      </mapping>
    </element>
    <element
             id="Observation.related-TNMClinicalDistantMetastasesCategory.target">
      <path value="Observation.related.target"/>
      <name
            value="Observation.related-TNMClinicalDistantMetastasesCategory.target"/>
      <short value="Resource that is related to this one"/>
      <definition
                  value="A reference to the observation or [[[QuestionnaireResponse]]] resource that is related to this observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalDistantMetastasesCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value=".targetObservation"/>
      </mapping>
    </element>
    <element id="Observation.component">
      <path value="Observation.component"/>
      <name 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."/>
      <comments
                value="For a discussion on the ways Observations can assembled in groups together see [Notes below](observation.html#4.20.4)."/>
      <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>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.component.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.component.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.component.code">
      <path value="Observation.component.code"/>
      <name 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;."/>
      <requirements
                    value="Knowing what kind of observation is being made is essential to understanding the observation."/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-7"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="Codes identifying names of simple observations."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-3"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="what"/>
      </mapping>
    </element>
    <element id="Observation.component.valuex">
      <path value="Observation.component.value[x]"/>
      <name value="Observation.component.valuex"/>
      <short value="Actual component result"/>
      <definition
                  value="The information determined as a result of making the observation, if the information has a simple value."/>
      <comments
                value="Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.   For boolean values use valueCodeableConcept and select codes from &lt;http://hl7.org/fhir/ValueSet/v2-0136&gt; (These &quot;yes/no&quot; concepts can be mapped to the display name &quot;true/false&quot; or other mutually exclusive terms that may be needed&quot;).  The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (The name format is &quot;&#39;value&#39; + the type name&quot; with a capital on the first letter of the type)."/>
      <requirements
                    value="An observation exists to have a value, though it may not if it is in error, or it represents a group of observations."/>
      <min value="0"/>
      <max value="1"/>
      <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>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="OBX.2, OBX.5, OBX.6"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value"/>
      </mapping>
    </element>
    <element id="Observation.component.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason"/>
      <name 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.value[x] is missing."/>
      <comments
                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"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-6"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description
                     value="Codes specifying why the result (Observation.value[x]) is missing."/>
        <valueSetReference>
          <reference
                     value="http://hl7.org/fhir/ValueSet/observation-valueabsentreason"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="N/A"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="value.nullFlavor"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/>
      <name 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."/>
      <comments
                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 may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties."/>
      <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="*"/>
      <type>
        <code value="BackboneElement"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.component.referenceRange.id"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition
                  value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comments
                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="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation.component.referenceRange.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/>
      <comments
                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"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Observation.component.referenceRange.low">
      <path value="Observation.component.referenceRange.low"/>
      <name 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"/>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-3"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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"/>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <maxLength value="0"/>
      <condition value="obs-3"/>
      <mustSupport value="false"/>
      <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.meaning">
      <path value="Observation.component.referenceRange.meaning"/>
      <name value="Observation.component.referenceRange.meaning"/>
      <short value="Indicates the meaning/use of this range of this range"/>
      <definition value="Code for the meaning of the reference range."/>
      <comments
                value="This SHOULD be populated if there is more than one range."/>
      <requirements
                    value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, or perhaps what state this reference range applies to (i.e. age, hormonal cycles, etc.)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
        </valueSetReference>
      </binding>
      <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"/>
      <name 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"/>
      <type>
        <code value="Range"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name 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 &#39;normals&#39;."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <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"/>
      <name value="Observation"/>
      <short value="onco-core-TNMClinicalStageGroup"/>
      <definition
                  value="The extent of the cancer in the body, according to the TNM classification system, based on information obtained prior to neoadjuvant treatment and surgery, e.g. based on evidence such as physical examination, imaging, and/or biopsy."/>
      <min value="0"/>
      <type>
        <code value="Observation"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.meta">
      <path value="Observation.meta"/>
      <name value="Observation.meta"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.meta.extension">
      <path value="Observation.meta.extension"/>
      <name value="Observation.meta.extension"/>
      <slicing id="3">
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="sourcesystem">
      <path value="Observation.meta.extension"/>
      <name value="sourcesystem"/>
      <definition
                  value="FHIR: This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
FHIM: Identifies the computer system that created the medical record. This optional field may also be used to indicate that the medical record was originally created by a different organization from the one that is currently storing or utilizing the record in that the assigning authority of the Id could be set to that originating organization. This property is optional, as some systems will assume that all records that it contains originated in that system, however it is anticipated that it will become increasingly commonplace for records from multiple systems and organizations will be comingled in order to provide a complete picture of the patient&#39;s health record."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.meta.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-SourceSystem-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.extension">
      <path value="Observation.extension"/>
      <name value="Observation.extension"/>
      <slicing id="2">
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="observationbasedon">
      <path value="Observation.extension"/>
      <name value="observationbasedon"/>
      <definition
                  value="The 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."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationBasedOn-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="observationpartof">
      <path value="Observation.extension"/>
      <name value="observationpartof"/>
      <definition
                  value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationPartOf-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="annotation">
      <path value="Observation.extension"/>
      <name value="annotation"/>
      <definition
                  value="An added or follow-up note, often after the fact, that contains metadata about who made the statement and when."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Annotation-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="observationderivedfrom">
      <path value="Observation.extension"/>
      <name value="observationderivedfrom"/>
      <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."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-ObservationDerivedFrom-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.modifierExtension">
      <path value="Observation.modifierExtension"/>
      <name value="Observation.modifierExtension"/>
      <slicing id="4">
        <discriminator value="url"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="focalsubject">
      <path value="Observation.modifierExtension"/>
      <name value="focalsubject"/>
      <definition
                  value="The person or entity that the information in this resource relates to, if different than the person of record. The subject of information can be a reference or a code, the latter when the subject is described generically, for example, in terms of a relationship to the subject of record (e.g., wife)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Observation.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-FocalSubject-extension"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.modifierExtension-focalsubject.valueReference">
      <path value="Observation.modifierExtension.valueReference"/>
      <name value="Observation.modifierExtension-focalsubject.valueReference"/>
      <short
             value="PrimaryCancerCondition: Records the history of the primary cancer condition, the original or first tumor in the body (reference https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-tumor)"/>
      <definition
                  value="Records the history of the primary cancer condition, the original or first tumor in the body (reference https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-tumor). Cancers that are not clearly secondary (i.e., of uncertain origin or behavior) should be documented as primary.

Cancer staging information summarized in this profile should reflect the most recent staging assessment on the patient, and should be updated if and when there is a new staging assessment. Past staging assessments will be preserved in instances of the TNMClinicalStageGroup and/or TNMPathologicalStageGroup, which refer back to PrimaryCancerCondition.

Conformance note: For the code attribute, to be compliant with [US Core Profiles](http://hl7.org/fhir/us/core/STU3/index.html), SNOMED CT must be used unless there is no suitable code, in which case ICD-10-CM can be used."/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-PrimaryCancerCondition"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.category">
      <path value="Observation.category"/>
      <name value="Observation.category"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Codes for high level observation categories ."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/observation-category"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.code">
      <path value="Observation.code"/>
      <name value="Observation.code"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding"/>
      <name value="Observation.code.coding"/>
      <slicing id="1">
        <discriminator value="code"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="1"/>
      <max value="*"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Fixed_21908-9">
      <path value="Observation.code.coding"/>
      <name value="Fixed_21908-9"/>
      <short value="Stage group.clinical Cancer"/>
      <definition value="Stage group.clinical Cancer"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.system">
      <path value="Observation.code.coding.system"/>
      <name value="Observation.code.coding-Fixed-21908-9.system"/>
      <min value="0"/>
      <fixedUri value="http://loinc.org"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.code.coding-Fixed-21908-9.code">
      <path value="Observation.code.coding.code"/>
      <name value="Observation.code.coding-Fixed-21908-9.code"/>
      <min value="0"/>
      <fixedCode value="21908-9"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject"/>
      <name value="Observation.subject"/>
      <short value="The subject of an observation"/>
      <definition value="The subject of an observation."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.subject"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.effectivex">
      <path value="Observation.effective[x]"/>
      <name value="Observation.effectivex"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer"/>
      <name value="Observation.performer"/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.valueCodeableConcept">
      <path value="Observation.valueCodeableConcept"/>
      <name value="Observation.valueCodeableConcept"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Observation.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference
                     value="http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-TNMStageGroupVS"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason"/>
      <name value="Observation.dataAbsentReason"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.dataAbsentReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite"/>
      <name value="Observation.bodySite"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.bodySite"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="preferred"/>
        <description
                     value="Codes describing anatomical locations. May include laterality."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/body-site"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.method">
      <path value="Observation.method"/>
      <name 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."/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <valueSetReference>
          <reference
                     value="http://mcodeinitiative.org/us/mcode/ValueSet/onco-core-CancerStagingSystemVS"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen"/>
      <name value="Observation.specimen"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.specimen"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.device">
      <path value="Observation.device"/>
      <name value="Observation.device"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.device"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://fhir.org/guides/argonaut/StructureDefinition/argo-device"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange"/>
      <name value="Observation.referenceRange"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.referenceRange"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.referenceRange.meaning">
      <path value="Observation.referenceRange.meaning"/>
      <name value="Observation.referenceRange.meaning"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.related">
      <path value="Observation.related"/>
      <name value="Observation.related"/>
      <slicing id="5">
        <discriminator value="target.reference/@profile"/>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related.type"/>
      <min value="0"/>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related.target"/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="onco-core-TNMClinicalPrimaryTumorCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalPrimaryTumorCategory"/>
      <short
             value="TNMClinicalPrimaryTumorCategory: Category of the primary tumor, based on its size and extent, assessed prior to surgery, based on evidence such as physical examination, imaging, and/or biopsy"/>
      <definition
                  value="Category of the primary tumor, based on its size and extent, assessed prior to surgery, based on evidence such as physical examination, imaging, and/or biopsy."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.type"/>
      <min value="0"/>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related-TNMClinicalPrimaryTumorCategory.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related-TNMClinicalPrimaryTumorCategory.target"/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalPrimaryTumorCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="onco-core-TNMClinicalRegionalNodesCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalRegionalNodesCategory"/>
      <short
             value="TNMClinicalRegionalNodesCategory: Category of the presence or absence of metastases in regional lymph nodes, assessed using tests that are done before surgery"/>
      <definition
                  value="Category of the presence or absence of metastases in regional lymph nodes, assessed using tests that are done before surgery. These include physical exams, imaging tests, laboratory tests (such as blood tests), and biopsies (definition adapted from NCI Dictionary of Cancer Terms)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.type">
      <path value="Observation.related.type"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.type"/>
      <min value="0"/>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related-TNMClinicalRegionalNodesCategory.target">
      <path value="Observation.related.target"/>
      <name value="Observation.related-TNMClinicalRegionalNodesCategory.target"/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalRegionalNodesCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="onco-core-TNMClinicalDistantMetastasesCategory">
      <path value="Observation.related"/>
      <name value="onco-core-TNMClinicalDistantMetastasesCategory"/>
      <short
             value="TNMClinicalDistantMetastasesCategory: Category describing the presence or absence of metastases in remote anatomical locations, assessed using tests that are done before surgery"/>
      <definition
                  value="Category describing the presence or absence of metastases in remote anatomical locations, assessed using tests that are done before surgery. These include physical exams, imaging tests, laboratory tests (such as blood tests), and biopsies (definition adapted from NCI Dictionary of Cancer Terms)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Observation.related"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.related-TNMClinicalDistantMetastasesCategory.type">
      <path value="Observation.related.type"/>
      <name
            value="Observation.related-TNMClinicalDistantMetastasesCategory.type"/>
      <min value="0"/>
      <fixedCode value="has-member"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element
             id="Observation.related-TNMClinicalDistantMetastasesCategory.target">
      <path value="Observation.related.target"/>
      <name
            value="Observation.related-TNMClinicalDistantMetastasesCategory.target"/>
      <min value="0"/>
      <type>
        <code value="Reference"/>
        <profile
                 value="http://mcodeinitiative.org/us/mcode/StructureDefinition/onco-core-TNMClinicalDistantMetastasesCategory"/>
      </type>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.component">
      <path value="Observation.component"/>
      <name value="Observation.component"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Observation.component"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.component.valuex">
      <path value="Observation.component.value[x]"/>
      <name value="Observation.component.valuex"/>
      <min value="0"/>
      <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>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.component.referenceRange">
      <path value="Observation.component.referenceRange"/>
      <name value="Observation.component.referenceRange"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Observation.component.referenceRange.meaning">
      <path value="Observation.component.referenceRange.meaning"/>
      <name value="Observation.component.referenceRange.meaning"/>
      <min value="0"/>
      <maxLength value="0"/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="extensible"/>
        <description value="Code for the meaning of a reference range."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/referencerange-meaning"/>
        </valueSetReference>
      </binding>
    </element>
  </differential>
</StructureDefinition>