Behavior

The SHR Behavior domain contains data definitions related to how the person of record acts, feels, or responds to situations.

AlcoholBingeFrequency

How often have you had 6 or more Units if female, or 8 or more if male, on a single occasion in the last year?. C0556346

Value:  CodeableConcept from SemiquantitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is C0556346 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.

AlcoholUse [Entry]

The history of the subject's use of alcohol. C0001948

Based On SubstanceUse

Value:  CodeableConcept from TBD A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is C0001948 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
Substance is alcohol (398624005) optional Any matter of defined composition that has discrete existence, whose origin may be biological, mineral or chemical.
AssessmentTool from AlcoholUseScreeningToolVS optional The name of the formal assessment or screening tool used to assess the behavior.
AlcoholBingeFrequency optional How often have you had 6 or more Units if female, or 8 or more if male, on a single occasion in the last year?.
ObservationCategory includes Substance Use (C024251) 1 or more A categorization of the observation according to how the observation was collected or its clinical area.
GeneralizedLikelihood optional Quantitative or qualitative measure of likelihood.
ExposureSourceOrVector 0 or more Where the substance originated. Vectors include animals (e.g., tick, mosquito, cats, livestock) capable of transmitting an infectious agent among vertebrates. Sources could include food, contaminated drinking water, air, radon gas in the home, etc.
AmountOrDosage (TBD) optional Description TBD
ExposureReason optional Why the exposure occurred.
ExposureMethod optional How the exposure occurred, e.g. cutaneous contact, injection, ingestion, sexual contact, inhalation.
RouteIntoBody optional The way a substance enters an organism after contact, particularly, the route of drug administration.
Test 0 or more A laboratory, radiologic, or other clinical test or measurement used to determine the presence, absence, or degree of a condition, or assess the function or health of an individual. This includes patient-generated data, such as pedometer readings.
Impact (TBD) 0 or more Description TBD
ObservationStatus from NonLabObservationStatusVS required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

AssessmentTool

The name of the formal assessment or screening tool used to assess the behavior.

Value:  CodeableConcept A set of codes drawn from different coding systems, representing the same concept.

BehavioralObservation

A statement about observable responses, actions, or activities of the subject. Can be used to assert or deny behaviors. C0004927

Based On Observation

ObservationCategory includes Behavior (54511-1) 1 or more A categorization of the observation according to how the observation was collected or its clinical area.
Impact (TBD) 0 or more Description TBD
ReadinessToChange optional How motivated the subject is to change the behavior, if the behavior is ongoing, and change would be beneficial.
ObservationCode required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationStatus required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

DietAndNutrition [Entry]

The usual food and drink consumed by an individual. C0012155

Based On Panel

Value:  CodeableConcept from TBD A set of codes drawn from different coding systems, representing the same concept.
PanelCode is C0012155 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The panel code provides the identity of the type of panel.
SpecialDietFollowed 0 or more A type of nutritional plan followed by the subject.
HasSufficientFood required
DietNutritionConcern 0 or more An anxiety or worry about the diet or nutritional intake of the subject.
FoodAllergy 0 or more An immune or biochemical adverse reaction to a food substance.
ServiceCategory optional A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ReportStatus required The status of the report associated with this panel.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Specimen (TBD) 0 or more Description TBD
Interpretation 0 or more A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

DietNutritionConcern

An anxiety or worry about the diet or nutritional intake of the subject.

Value:  CodeableConcept from DietNutritionConcernVS A set of codes drawn from different coding systems, representing the same concept.

ExerciseHoursPerWeek

Hours of moderate or vigorous activity per week.

Value:  unsignedInt

HasSufficientFood

No Description

Value:  CodeableConcept from QualitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.

HoursSleepPerNight

Typical hours spent sleeping per night. 65968-0

Value:  positiveInt

IntravenousDrugUse [Entry]

Records whether the subject injects recreational drugs. C0242566

Based On SubstanceUse

Value:  CodeableConcept from ThreeValueLogicVS A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is C0242566 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
RouteIntoBody is Intravenous route (C1522726) required The way a substance enters an organism after contact, particularly, the route of drug administration.
ExposureMethod is Intravenous Injection (C0021494) required How the exposure occurred, e.g. cutaneous contact, injection, ingestion, sexual contact, inhalation.
Substance from SubstanceOfAbuseVS optional Any matter of defined composition that has discrete existence, whose origin may be biological, mineral or chemical.
ObservationCategory includes Substance Use (C024251) 1 or more A categorization of the observation according to how the observation was collected or its clinical area.
GeneralizedLikelihood optional Quantitative or qualitative measure of likelihood.
ExposureSourceOrVector 0 or more Where the substance originated. Vectors include animals (e.g., tick, mosquito, cats, livestock) capable of transmitting an infectious agent among vertebrates. Sources could include food, contaminated drinking water, air, radon gas in the home, etc.
AmountOrDosage (TBD) optional Description TBD
ExposureReason optional Why the exposure occurred.
Test 0 or more A laboratory, radiologic, or other clinical test or measurement used to determine the presence, absence, or degree of a condition, or assess the function or health of an individual. This includes patient-generated data, such as pedometer readings.
Impact (TBD) 0 or more Description TBD
ObservationStatus from NonLabObservationStatusVS required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

NicotineUse [Entry]

Records the history of a subject's use of nicotine. C2363943

Based On SubstanceUse

Value:  CodeableConcept from http://hl7.org/fhir/us/core/ValueSet/us-core-observation-ccdasmokingstatus A set of codes drawn from different coding systems, representing the same concept.
Substance is C2363943 optional Any matter of defined composition that has discrete existence, whose origin may be biological, mineral or chemical.
ObservationCode is 11367-0 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
RouteIntoBody from TBD optional The way a substance enters an organism after contact, particularly, the route of drug administration.
ExposureMethod from TBD optional How the exposure occurred, e.g. cutaneous contact, injection, ingestion, sexual contact, inhalation.
ObservationCategory includes Substance Use (C024251) 1 or more A categorization of the observation according to how the observation was collected or its clinical area.
GeneralizedLikelihood optional Quantitative or qualitative measure of likelihood.
ExposureSourceOrVector 0 or more Where the substance originated. Vectors include animals (e.g., tick, mosquito, cats, livestock) capable of transmitting an infectious agent among vertebrates. Sources could include food, contaminated drinking water, air, radon gas in the home, etc.
AmountOrDosage (TBD) optional Description TBD
ExposureReason optional Why the exposure occurred.
Test 0 or more A laboratory, radiologic, or other clinical test or measurement used to determine the presence, absence, or degree of a condition, or assess the function or health of an individual. This includes patient-generated data, such as pedometer readings.
Impact (TBD) 0 or more Description TBD
ObservationStatus from NonLabObservationStatusVS required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

ONCSmokingStatus [Entry]

Records the subject's use of tobacco. 11367-0

Based On CodeableConceptObservation

Value:  CodeableConcept from http://hl7.org/fhir/us/core/ValueSet/us-core-observation-ccdasmokingstatus A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is 11367-0 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
ObservationCategory 0 or more A categorization of the observation according to how the observation was collected or its clinical area.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationStatus required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

PhysicalActivityLevel [Entry]

The amount of exercise or other physical activity compared to others of the same age. See BMC Medical Research Methodology 2012 12:20 1471-2288. C0026606

Based On Panel

Value:  CodeableConcept from QualitativeValueScaleVS A set of codes drawn from different coding systems, representing the same concept.
PanelCode is 28323-4 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The panel code provides the identity of the type of panel.
ExerciseHoursPerWeek optional Hours of moderate or vigorous activity per week.
PhysicalActivityLimitation 0 or more Anything that limits physical activity, including health factors, logistical, monetary, or social restrictions.
MetabolicEquivalent (TBD) optional Description TBD
ServiceCategory optional A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ReportStatus required The status of the report associated with this panel.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Specimen (TBD) 0 or more Description TBD
Interpretation 0 or more A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

PhysicalActivityLimitation

Anything that limits physical activity, including health factors, logistical, monetary, or social restrictions.

Value:  CodeableConcept from PhysicalActivityLimitationVS A set of codes drawn from different coding systems, representing the same concept.

ReadinessToChange

How motivated the subject is to change the behavior, if the behavior is ongoing, and change would be beneficial.

Value:  CodeableConcept from QualitativeLikelihoodVS A set of codes drawn from different coding systems, representing the same concept.

ReligiousCongregation

A group of place of religious practice.

Value:  string

ReligiousPractice [Entry]

The religion practiced by the focal subject. C0035039

Based On CodeableConceptObservation

Value:  CodeableConcept from http://hl7.org/fhir/v3/ReligiousAffiliation A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is 81364-2 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
ReligiousPracticeStatus optional The extent to which the religious practice is actively followed.
ReligiousRestriction 0 or more Any restriction on that derives from religion and may impact medical treatment, other than dietary (handled elsewhere).
ReligiousCongregation optional A group of place of religious practice.
ReligiousRepresentative (TBD) optional Description TBD
ObservationCategory 0 or more A categorization of the observation according to how the observation was collected or its clinical area.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationStatus required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

ReligiousPracticeStatus

The extent to which the religious practice is actively followed.

Value:  CodeableConcept from ReligiousPracticeStatusVS A set of codes drawn from different coding systems, representing the same concept.

ReligiousRestriction

Any restriction on that derives from religion and may impact medical treatment, other than dietary (handled elsewhere).

Value:  CodeableConcept from ReligiousRestrictionVS A set of codes drawn from different coding systems, representing the same concept.

SleepQuality [Entry]

Self-reported sleep quality. C0424563

Based On Panel

Value:  CodeableConcept from PerformanceGradingScaleVS A set of codes drawn from different coding systems, representing the same concept.
PanelCode is 28323-4 required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The panel code provides the identity of the type of panel.
TroubleFallingAsleep optional How often the subject has trouble falling asleep.
TroubleStayingAsleep optional How often the subject has trouble staying asleep.
WakeFeelingRested optional How often the subject feels rested when they wake up.
HoursSleepPerNight optional Typical hours spent sleeping per night.
SleepQualityReason 0 or more Reason for poor sleep quality.
ServiceCategory optional A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ReportStatus required The status of the report associated with this panel.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Specimen (TBD) 0 or more Description TBD
Interpretation 0 or more A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

SleepQualityReason

Reason for poor sleep quality.

Value:  CodeableConcept from SleepQualityReasonVS A set of codes drawn from different coding systems, representing the same concept.

SpecialDietFollowed

A type of nutritional plan followed by the subject.

Value:  CodeableConcept from SpecialDietFollowedVS A set of codes drawn from different coding systems, representing the same concept.

SubstanceAbuseTreatment [Entry]

The treatment program used to address a substance abuse problem.

Based On Procedure

Value:  CodeableConcept from SubstanceAbuseTreatmentTypeVS A set of codes drawn from different coding systems, representing the same concept.
ProcedureStatus required A code specifying the state of the procedure. Generally this will be in-progress or completed state.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur, or the the thing documented is absent or does not exist.
OccurrenceTime optional The point in time or span of time in which something happens.
ProcedureParticipant 0 or more
Facility optional Services and space and equipment provided for a particular purpose; a building or place that provides a particular service or is used for a particular industry. Could be a clinical site, community site, or a mobile facility.
Reason 0 or more The justification for an action or non-action, conclusion, opinion, etc.

SubstanceUse [Entry]

Assertion concerning the past or current use of a substance (alcohol, recreational drugs, illegal drugs, or abuse of prescription medication) that could negatively impact the subject's health. C024251

Based On ExposureToSubstance

Value:  CodeableConcept A set of codes drawn from different coding systems, representing the same concept.
Substance from SubstanceOfAbuseVS optional Any matter of defined composition that has discrete existence, whose origin may be biological, mineral or chemical.
ObservationCategory includes Substance Use (C024251) 1 or more A categorization of the observation according to how the observation was collected or its clinical area.
GeneralizedLikelihood optional Quantitative or qualitative measure of likelihood.
ExposureSourceOrVector 0 or more Where the substance originated. Vectors include animals (e.g., tick, mosquito, cats, livestock) capable of transmitting an infectious agent among vertebrates. Sources could include food, contaminated drinking water, air, radon gas in the home, etc.
AmountOrDosage (TBD) optional Description TBD
ExposureReason optional Why the exposure occurred.
ExposureMethod optional How the exposure occurred, e.g. cutaneous contact, injection, ingestion, sexual contact, inhalation.
RouteIntoBody optional The way a substance enters an organism after contact, particularly, the route of drug administration.
Test 0 or more A laboratory, radiologic, or other clinical test or measurement used to determine the presence, absence, or degree of a condition, or assess the function or health of an individual. This includes patient-generated data, such as pedometer readings.
Impact (TBD) 0 or more Description TBD
ObservationStatus from NonLabObservationStatusVS required A qualifier describing the stage or administrative state of the observation. If not given, it is assumed the status is final.
ObservationCode required A term from a controlled vocabulary that defines the data element (the question, not the answer) as specifically as possible. The specific code should always align with the concept of the element, but may be more specific. For example, the concept associated with medications is code for 'medication used', but the ObservationCode is the code for the particular medication used. For tests, ObservationCode identifies the specific test being performed, and for observations, the specific question being asked.
ObservationReason optional The reason for making the observation.
ObservationNonOccurrenceModifier optional True if the observation did not occcur, e.g., if a test was not performed or the assessment was not done, when it might otherwise be expected.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
ObservationMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ClinicallyRelevantTime optional The time or time period that the observation addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
Participant 0 or more A statement about an actor who did (or did not) participate in a certain task or activity. Unlike a HealthcareInvolvement which continues over period of time, the participant is associated with doing or not doing a specific task, such admitting a patient, performing a procedure, or taking a measurement.
Setting 0 or more Description of the place or type of surroundings where something is positioned or where an event takes place.
Location 0 or more A position, site, or point in space where something can be found.

TroubleFallingAsleep

How often the subject has trouble falling asleep.

Value:  CodeableConcept from QualitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.

TroubleStayingAsleep

How often the subject has trouble staying asleep.

Value:  CodeableConcept from QualitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.

ViolentBehaviorRisk [Entry]

Risk or danger posed by the focal subject to others and/or his or herself due to violent behavior.

Based On TBD

ViolentRiskToOthers required Risk or danger posed by the focal subject to others.
ViolentRiskToSelf required Risk or danger posed by the focal subject to his or herself.

ViolentRiskToOthers

Risk or danger posed by the focal subject to others.

Value:  CodeableConcept from QualitativeValueScaleVS A set of codes drawn from different coding systems, representing the same concept.
Explanation optional A set of statements describing a group of facts that clarifies the cause, context and/or consequence of those facts.

ViolentRiskToSelf

Risk or danger posed by the focal subject to his or herself.

Value:  CodeableConcept from QualitativeValueScaleVS A set of codes drawn from different coding systems, representing the same concept.
Explanation optional A set of statements describing a group of facts that clarifies the cause, context and/or consequence of those facts.

WakeFeelingRested

How often the subject feels rested when they wake up.

Value:  CodeableConcept from QualitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.