Skip to main content

Oncology

SHR implementation of ASCO requirements.

BRCA1Variant

Whether the patient has a mutation in the BRCA1 gene.

Based On GeneticVariant

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
GeneIdentifier is BRCA1 required A unique code for a gene, including protein coding genes, ncRNA genes and pseudogenes, to allow unambiguous communication, drawn from HUGO Gene Nomenclature Committee.
Refseq optional The Reference Sequence (RefSeq) collection provides a comprehensive, integrated, non-redundant, well-annotated set of sequences, including genomic DNA, transcripts, and proteins. RefSeq sequences form a foundation for medical, functional, and diversity studies. They provide a stable reference for genome annotation, gene identification and characterization, mutation and polymorphism analysis (especially RefSeqGene records), expression studies, and comparative analyses.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

BRCA2Variant

Whether the patient has a mutation in the BRCA2 gene.

Based On GeneticVariant

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
GeneIdentifier is BRCA2 required A unique code for a gene, including protein coding genes, ncRNA genes and pseudogenes, to allow unambiguous communication, drawn from HUGO Gene Nomenclature Committee.
Refseq optional The Reference Sequence (RefSeq) collection provides a comprehensive, integrated, non-redundant, well-annotated set of sequences, including genomic DNA, transcripts, and proteins. RefSeq sequences form a foundation for medical, functional, and diversity studies. They provide a stable reference for genome annotation, gene identification and characterization, mutation and polymorphism analysis (especially RefSeqGene records), expression studies, and comparative analyses.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

BreastCancer [Entry]

A cancer originating in the tissues of the breast, and potentially spread to other organs of the body. C1446377

Based On Condition

Value:  CodeableConcept must be from BreastCancerTypeVS A set of codes drawn from different coding systems, representing the same concept.
Category includes disease 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
Stage must be from TBD optional The relative advancement in the course of a disease.
BodySite must be a PrimaryTumorSite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
ClinicalStatus required A flag indicating whether the condition is active or inactive, recurring, in remission, or resolved (as of the last update of the Condition).
IncludeOnProblemList optional Whether or not to include this condition on the subject's current problem list.
Onset optional The beginning or first appearance of a mental or physical disorder.
WhenClinicallyRecognized optional The time at which a condition or condition was first identified in a healthcare context.
Preexisting optional If the problem or condition existed before the current episode of care.
Abatement optional The end, remission or resolution.
Severity optional Degree of harshness or extent of a symptom, disorder, or condition.
Criticality optional The potential clinical harm associated with a condition. When the worst case result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.
Observation 0 or more An Observation represents evidence, both subjective and objective. Observation includes any information about a subject that results from an act of observing, measuring, or evaluation. The focus of an observation can include the subject's behavior, physiological state, health state, functional status, environment, exposures to substances, etc. An Observation contains information about the act of observing or measuring, and the result of the observation. The method of observing can vary widely, from questioning, physical examination, formal assessment vehicles, laboratory tests, imaging procedures, etc. Patient-reported information is also considered an observation, where subject and observer are the same individual.

BreastCancerGeneticAnalysis [Entry]

The status of genes known or suspected to play a role in breast cancer risk, for example, the tumor suppressor genes, BRCA1 and BRCA2.

Based On Panel

Value:  Choice
         |  Quantity required A quantity with units.
         |  CodeableConcept could be from ObservationResultVS required A set of codes drawn from different coding systems, representing the same concept.
         |  string required
         |  boolean required
         |  Range required An interval defined by an upper and/or lower bound. One of the two bounds must be specified, and the lower bound must be less than the upper bound.
         |  Ratio required A unit of measurement for the quotient of the amount of one entity to another.
         |  time required
         |  dateTime required
         |  TimePeriod required A period of time defined by a start and end time, date, or year.
BRCA1Variant required Whether the patient has a mutation in the BRCA1 gene.
BRCA2Variant required Whether the patient has a mutation in the BRCA2 gene.
DataAbsentReason not used Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
PanelMembers required PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

BreastCancerReceptorStatus [Entry]

Immunohistochemistry (IHC) assessment for estrogen receptor (ER) and progesterone receptor (PR) as well as IHC or in situ hybridization (ISH) determination of human epidermal growth factor receptor 2 (HER2) status

Based On Panel

Value:  Choice
         |  Quantity required A quantity with units.
         |  CodeableConcept could be from ObservationResultVS required A set of codes drawn from different coding systems, representing the same concept.
         |  string required
         |  boolean required
         |  Range required An interval defined by an upper and/or lower bound. One of the two bounds must be specified, and the lower bound must be less than the upper bound.
         |  Ratio required A unit of measurement for the quotient of the amount of one entity to another.
         |  time required
         |  dateTime required
         |  TimePeriod required A period of time defined by a start and end time, date, or year.
SpecificType is TBD required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Specimen (TBD) required Description TBD
EstrogenReceptorStatus optional Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options.
ProgesteroneReceptorStatus optional Progesterone receptor is expressed in 65% of breast carcinomas. PR status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options.
HumanEpiduralGrowthFactorReceptor2Status optional HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors,10 and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options.
DataAbsentReason not used Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
PanelMembers required PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

CancerGrowthPotential [Entry]

Information relating to rate of cell growth or proportion of cancer cells within the tumor that are growing and dividing to form new cancer cells. Cancer Cell Growth (C1516170)

Based On Observation

Value:  CodeableConcept must be from QualitativeValueScaleVS A set of codes drawn from different coding systems, representing the same concept.
Ki-67LabelingIndex optional Ki-67 is a protein phosphatase whose expression is strongly associated with cell proliferation and encoded by the MKI67 gene. The Ki67 labeling index is the fraction of Ki-67-positive cells to total cells in a tumor specimen and may be useful for determining prognosis with respect to survival and disease recurrence. The more positive cells there are, the more quickly they are dividing and forming new cells. ReferenceRange: Low <10, Intermediate 10-20, >20 High
S-PhaseFraction optional An expression of the number of mitoses found in a stated number of cells. The S-phase fraction number tells you what percentage of cells in the tissue sample are in the process of copying their genetic information (DNA). This S-phase, short for synthesis phase, happens just before a cell divides into two new cells. ReferenceRange: Low <6, Intermediate 6-10, >10 High.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

CancerLymphaticInvolvement [Entry]

Whether or not lymph nodes contain cancer cells. C0746333

Based On Observation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
LymphaticSystemSubdivision required A lymph node area or nodal group; a subdivision of the entire lymphatic system. For breast cancer, this includes 5 areas: internal mammary lymph nodes, axillary lymph nodes level I, II, and III, and the supraclavicular lymph nodes.
LargestLymphNodeSize optional The largest dimension of the largest lymph node invaded by cancer cells.
NumberOfLymphNodesInvolved optional A count of lymph nodes invaded by cancer cells of those examined.
DegreeOfLymphaticInvolvement optional Assessment of how much cancer is in a lymph node.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

Cellularity

Percentage of cells in a sample that are cancerous C4055283

Based On ObservationComponent

Value:  Quantity Units is % A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

DegreeOfLymphaticInvolvement

Assessment of how much cancer is in a lymph node.

Based On ObservationComponent

Value:  CodeableConcept must be from DegreeOfLymphaticInvolvementVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

EstrogenReceptorStatus [Entry]

Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options.

Based On ReceptorStatusObservation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType is 16112-5 required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
ReceptorType is 23307004 required A protein located on the cell surface, or in the cytoplasm, that binds to a specific signaling factor, such as a hormone, antigen, or neurotransmitter, causing a conformational and functional change in the receptor molecule. The ligand-bound receptor then alters its interaction with target molecules, which leads to changes in cellular physiology through modification of the activity of one or more signal transduction pathways.
ReceptorPositivityPercentage optional The percentage of cells that test (stain) positive for the presence of a receptor.
ReceptorAllredTotalScore optional Part of the Allred scoring, the total of proportion and intensity scores, from 0 to 8.
ReceptorProportionScore optional Part of Allred scoring, based on the percentage of cells that stain for a receptor, on a scale of 0 to 5.
ReceptorIntensityScore optional Part of the Allred scoring, based on the intensity of that staining, on a scale of 0 to 3.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

GeneIdentifier

A unique code for a gene, including protein coding genes, ncRNA genes and pseudogenes, to allow unambiguous communication, drawn from HUGO Gene Nomenclature Committee. C1706509

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

GeneticVariant

Whether the patient carries a mutation in a particular gene. C0678941

Based On Observation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
GeneIdentifier required A unique code for a gene, including protein coding genes, ncRNA genes and pseudogenes, to allow unambiguous communication, drawn from HUGO Gene Nomenclature Committee.
Refseq optional The Reference Sequence (RefSeq) collection provides a comprehensive, integrated, non-redundant, well-annotated set of sequences, including genomic DNA, transcripts, and proteins. RefSeq sequences form a foundation for medical, functional, and diversity studies. They provide a stable reference for genome annotation, gene identification and characterization, mutation and polymorphism analysis (especially RefSeqGene records), expression studies, and comparative analyses.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

HistologicGrade [Entry]

The Elston Grade/Nottingham Score, representative of the aggressive potential of the tumor. Well differentiated (Grade 1) look similar to normal cells and are usually slow growing, while poorly differentiated cells (Grade 3) look very different than normal and are fast-growing. C1511980

Based On Observation

Value:  CodeableConcept must be from NottinghamCombinedGradeVS A set of codes drawn from different coding systems, representing the same concept.
TubuleFormationScore optional A comparison between structures formed by the tumor cells as opposed to those formed by normal cells. Scored 1 to 3 with 3 being the most abnormal.
NuclearPleomorphismScore optional How large and varied the nuclei of the tumor cells are. Scored 1 to 3, with 3 being the most pleomorphism.
MitoticCountScore optional How fast the tumor cells are growing and dividing, determined from the number of mitotic cells present. Scored 1 to 3, with 3 being the most mitotic cells.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

HumanEpiduralGrowthFactorReceptor2Status [Entry]

HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors,10 and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options. C3810543

Based On ReceptorStatusObservation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType is 48676-1 required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
ReceptorType is TBD required A protein located on the cell surface, or in the cytoplasm, that binds to a specific signaling factor, such as a hormone, antigen, or neurotransmitter, causing a conformational and functional change in the receptor molecule. The ligand-bound receptor then alters its interaction with target molecules, which leads to changes in cellular physiology through modification of the activity of one or more signal transduction pathways.
Method must be from HER2MethodVS optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
ReceptorPositivityPercentage optional The percentage of cells that test (stain) positive for the presence of a receptor.
ReceptorAllredTotalScore optional Part of the Allred scoring, the total of proportion and intensity scores, from 0 to 8.
ReceptorProportionScore optional Part of Allred scoring, based on the percentage of cells that stain for a receptor, on a scale of 0 to 5.
ReceptorIntensityScore optional Part of the Allred scoring, based on the intensity of that staining, on a scale of 0 to 3.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

Ki-67LabelingIndex

Ki-67 is a protein phosphatase whose expression is strongly associated with cell proliferation and encoded by the MKI67 gene. The Ki67 labeling index is the fraction of Ki-67-positive cells to total cells in a tumor specimen and may be useful for determining prognosis with respect to survival and disease recurrence. The more positive cells there are, the more quickly they are dividing and forming new cells. ReferenceRange: Low <10, Intermediate 10-20, >20 High C4049944

Based On ObservationComponent

Value:  Quantity Units is % A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

LargestLymphNodeSize

The largest dimension of the largest lymph node invaded by cancer cells. C1285847

Based On ObservationComponent

Value:  Quantity Units is mm A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

LymphaticSystemSubdivision

A lymph node area or nodal group; a subdivision of the entire lymphatic system. For breast cancer, this includes 5 areas: internal mammary lymph nodes, axillary lymph nodes level I, II, and III, and the supraclavicular lymph nodes.

Based On BodySite

Value:  CodeableConcept must be from LymphSystemSubdivisionVS A set of codes drawn from different coding systems, representing the same concept.
Laterality optional Anatomical location or specimen further detailing the side(s) of interest.
Directionality optional Anatomical location or specimen further detailing directionality.
PortionTotality optional ObservationQualifier for anatomical location or specimen further detailing the portion or totality, which means arrangement of, or apportioning of an entity.
ClockDirection optional A direction indicated by an angle relative to 12 o'clock.
Distance optional The space separating two objects or points.
Description optional An account, representation, statement, or explanation of something.
BodySiteMarker optional A marker surgically placed at the site, often during a biopsy procedure, to pinpoint the location. The marker is typically a metal clip or radioactive seed.

M-Stage

Part of the TNM classification system representing metastases. The system is used to describe the spread of cancer to other parts of the body. See Table 144 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm 59522-3

Based On ObservationComponent

Value:  CodeableConcept must be from TBD A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

MitoticCountScore

How fast the tumor cells are growing and dividing, determined from the number of mitotic cells present. Scored 1 to 3, with 3 being the most mitotic cells. 371472000

Based On ObservationComponent

Value:  Quantity A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

N-Stage

The presence of metastases in regional lymph nodes. TNM node category for staging derived from the American Joint Committee on Cancer. See Table 147 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm 59525-6

Based On ObservationComponent

Value:  CodeableConcept must be from TBD A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

NeoplasmObservation [Entry]

Observation of a unusual growth, for example, a tumor. The body site allows the abnormality to be located and identified. The abnormality identifier allows the tumor to be tracked over time.

Based On BodyStructureObservation

Value:  CodeableConcept must be from NeoplasmObservationVS A set of codes drawn from different coding systems, representing the same concept.
Identifier optional A unique string that identifies a specific person or thing.
Method must be from NeoplasmObservationMethodVS optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

NuclearPleomorphismScore

How large and varied the nuclei of the tumor cells are. Scored 1 to 3, with 3 being the most pleomorphism.

Based On ObservationComponent

Value:  CodeableConcept must be from NuclearPleomorphismScoreVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

NumberOfLymphNodesInvolved

A count of lymph nodes invaded by cancer cells of those examined.

Based On ObservationComponent

Value:  Quantity Units is Count (1) A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

PercentageInSituCarcinoma

The percentage of the cancer that is in situ, as opposed to invading other tissues.

Based On ObservationComponent

Value:  Quantity Units is % A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

PrimaryTumorSite

The location of the primary tumor. C0475447

Based On BodySite

Value:  CodeableConcept must be from BodySiteVS A set of codes drawn from different coding systems, representing the same concept.
Laterality optional Anatomical location or specimen further detailing the side(s) of interest.
Directionality optional Anatomical location or specimen further detailing directionality.
PortionTotality optional ObservationQualifier for anatomical location or specimen further detailing the portion or totality, which means arrangement of, or apportioning of an entity.
ClockDirection optional A direction indicated by an angle relative to 12 o'clock.
Distance optional The space separating two objects or points.
Description optional An account, representation, statement, or explanation of something.
BodySiteMarker optional A marker surgically placed at the site, often during a biopsy procedure, to pinpoint the location. The marker is typically a metal clip or radioactive seed.

ProgesteroneReceptorStatus [Entry]

Progesterone receptor is expressed in 65% of breast carcinomas. PR status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options. C1514471

Based On ReceptorStatusObservation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType is 16113-3 required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
ReceptorType is C0034833 required A protein located on the cell surface, or in the cytoplasm, that binds to a specific signaling factor, such as a hormone, antigen, or neurotransmitter, causing a conformational and functional change in the receptor molecule. The ligand-bound receptor then alters its interaction with target molecules, which leads to changes in cellular physiology through modification of the activity of one or more signal transduction pathways.
ReceptorPositivityPercentage optional The percentage of cells that test (stain) positive for the presence of a receptor.
ReceptorAllredTotalScore optional Part of the Allred scoring, the total of proportion and intensity scores, from 0 to 8.
ReceptorProportionScore optional Part of Allred scoring, based on the percentage of cells that stain for a receptor, on a scale of 0 to 5.
ReceptorIntensityScore optional Part of the Allred scoring, based on the intensity of that staining, on a scale of 0 to 3.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

Progression [Entry]

A finding related to the current trend of a disease. This concept is most often used for chronic and incurable diseases where the status and trendline of the disease is an important determinant of therapy and prognosis. The specific disorder being evaluated must be cited in the AssessmentFocus as a reference to a Condition. C0449258

Based On Assessment

Value:  CodeableConcept must be from SubjectiveProgressionVS A set of codes drawn from different coding systems, representing the same concept.
Category includes Progression (C0421176) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
AssessmentFocus required The topic or target of an analysis or assessment. For example, if the question involves the progression of the subject's diabetes, then the FocalCondition would be diabetes. If the investigation involves the toxicity of chemotherapy regimen, the focus would be that regimen (currently the MedicationUse of the chemotherapy drug). If the analysis involves certain observations, they would be listed as the focus.
Evidence must be from ProgressionEvidenceTypeVS 0 or more An observation that serves as evidence for some type of assessment.
Status must be from http://hl7.org/fhir/ValueSet/clinical-impression-status required The position of affairs at a particular time
AssessmentResult 0 or more A statement of judgment or opinion, often the outcome, finding, or conclusion of the investigation or analysis.
Method 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).
EvidenceQuality optional An estimate of the quality and/or quantity of the source information that supports the assessment.
Summary optional A shortened version of an item of information, containing only the main points.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
Reason 0 or more The justification for an action or non-action, conclusion, opinion, etc.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

ReceptorAllredTotalScore

Part of the Allred scoring, the total of proportion and intensity scores, from 0 to 8.

Based On ObservationComponent

Value:  Quantity A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

ReceptorIntensityScore

Part of the Allred scoring, based on the intensity of that staining, on a scale of 0 to 3.

Based On ObservationComponent

Value:  Quantity A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

ReceptorPositivityPercentage

The percentage of cells that test (stain) positive for the presence of a receptor.

Based On ObservationComponent

Value:  Quantity Units is % A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

ReceptorProportionScore

Part of Allred scoring, based on the percentage of cells that stain for a receptor, on a scale of 0 to 5.

Based On ObservationComponent

Value:  Quantity A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

ReceptorStatusObservation [Entry]

Refers to the presence or absence of specific receptor molecules on the surface of a cells in a specimen. C0449443

Based On Observation

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
ReceptorType required A protein located on the cell surface, or in the cytoplasm, that binds to a specific signaling factor, such as a hormone, antigen, or neurotransmitter, causing a conformational and functional change in the receptor molecule. The ligand-bound receptor then alters its interaction with target molecules, which leads to changes in cellular physiology through modification of the activity of one or more signal transduction pathways.
ReceptorPositivityPercentage optional The percentage of cells that test (stain) positive for the presence of a receptor.
ReceptorAllredTotalScore optional Part of the Allred scoring, the total of proportion and intensity scores, from 0 to 8.
ReceptorProportionScore optional Part of Allred scoring, based on the percentage of cells that stain for a receptor, on a scale of 0 to 5.
ReceptorIntensityScore optional Part of the Allred scoring, based on the intensity of that staining, on a scale of 0 to 3.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

ReceptorType

A protein located on the cell surface, or in the cytoplasm, that binds to a specific signaling factor, such as a hormone, antigen, or neurotransmitter, causing a conformational and functional change in the receptor molecule. The ligand-bound receptor then alters its interaction with target molecules, which leads to changes in cellular physiology through modification of the activity of one or more signal transduction pathways. C0597357

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

Refseq

The Reference Sequence (RefSeq) collection provides a comprehensive, integrated, non-redundant, well-annotated set of sequences, including genomic DNA, transcripts, and proteins. RefSeq sequences form a foundation for medical, functional, and diversity studies. They provide a stable reference for genome annotation, gene identification and characterization, mutation and polymorphism analysis (especially RefSeqGene records), expression studies, and comparative analyses.

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

S-PhaseFraction

An expression of the number of mitoses found in a stated number of cells. The S-phase fraction number tells you what percentage of cells in the tissue sample are in the process of copying their genetic information (DNA). This S-phase, short for synthesis phase, happens just before a cell divides into two new cells. ReferenceRange: Low <6, Intermediate 6-10, >10 High. C0812425

Based On ObservationComponent

Value:  Quantity Units is % A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

SizeOfGrossTumorBed

The largest dimension of the gross tumor bed/fibrotic area.

Based On ObservationComponent

Value:  Quantity Units is mm A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

StagingSystem

What staging system are used

Value:  string
Version optional A string identifying the particular of form of something (such as a code system or software product) that is different in some way from another form of the same thing.

StagingTiming

Indicates when the staging was done, in terms of treatment landmarks, for example, at diagnosis (clinical), at surgery(pathologic), after treatment (post-neoadjuvant), at entry to a clinical trial, or at recurrence.

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

T-Stage

The size and extent of the primary tumor (greatest dimension), based on criteria from the American Joint Committee on Cancer. See Table 152 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm 59528-0

Based On ObservationComponent

Value:  CodeableConcept must be from TBD A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

TNMStage [Entry]

The stage of a cancer, assessed according to the standard established by American Joint Committee on Cancer (AJCC). TNM Stage Grouping categorizes the progression of cancer using the Roman Numeral system. See Table 140 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm 21908-9

Based On Observation

Value:  CodeableConcept must be from TBD A set of codes drawn from different coding systems, representing the same concept.
StagingSystem required What staging system are used
StagingTiming optional Indicates when the staging was done, in terms of treatment landmarks, for example, at diagnosis (clinical), at surgery(pathologic), after treatment (post-neoadjuvant), at entry to a clinical trial, or at recurrence.
T-Stage required The size and extent of the primary tumor (greatest dimension), based on criteria from the American Joint Committee on Cancer. See Table 152 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm
N-Stage required The presence of metastases in regional lymph nodes. TNM node category for staging derived from the American Joint Committee on Cancer. See Table 147 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm
M-Stage required Part of the TNM classification system representing metastases. The system is used to describe the spread of cancer to other parts of the body. See Table 144 in HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.

ToxicReaction [Entry]

An adverse reaction to medication, radiation treatment, or other therapy, that causes grade 3 or 4 adverse reaction.

Based On AdverseReaction

Value:  CodeableConcept must be from MedDRAVS A set of codes drawn from different coding systems, representing the same concept.
AdverseEventGrade must be from ToxicReactionVS required A coded value specifying the level of injury suffered by the subject for whom the event is reported, using the CTCAE coding system.
AdverseReactionAttribution 0 or more A possible cause of the adverse reaction (either known or theorized). There can be more than one possible cause.
ActionTakenWithMedication (TBD) optional Description TBD
OtherActionTaken (TBD) optional Description TBD
SeriousAdverseEvent optional Clinical significance of adverse event defined based on the patient and event outcome or action criteria usually associated with events that pose a threat to a patient's life or functioning. Seriousness of adverse event serves as a primary guide for defining regulatory reporting obligations and changes in medicinal product development and usage.
PatternOfEvent (TBD) optional Description TBD
AdverseEventOutcome optional The eventual result and impact of an adverse event
AssociatedStudy optional The clinical trial or other formal study related to this finding.

TubuleFormationScore

A comparison between structures formed by the tumor cells as opposed to those formed by normal cells. Scored 1 to 3 with 3 being the most abnormal. 371470008

Based On ObservationComponent

Value:  CodeableConcept must be from TubuleFormationScoreVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

TumorMarginDescription

Description of the edge or border of tumor in situ by radiologist or of removed tumor by pathologist.

Based On ObservationComponent

Value:  CodeableConcept must be from TumorMarginDescriptionVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

TumorMargins

The edge or border of the tissue removed in cancer surgery. The margin is described as negative or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. The margin is described as positive or involved when the pathologist finds cancer cells at the edge of the tissue, suggesting that all of the cancer has not been removed. C1269830

Based On ObservationComponent

Value:  CodeableConcept must be from PositiveNegativeVS A set of codes drawn from different coding systems, representing the same concept.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

TumorSecondaryDimensionSize

The longest perpendicular diameter of the primary tumor.

Based On ObservationComponent

Value:  Quantity Units is mm A quantity with units.
SpecificType optional A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
Interpretation optional A clinical interpretation of a measurement.
ReferenceRange 0 or more The usual or acceptable range for a test result.

TumorSize [Entry]

Measurement of the longest diameter of a tumor, in situ or on a excised tumor. See CDISC Table 3.3.2 C4086369

Based On Observation

Value:  Quantity Units is mm A quantity with units.
Specimen (TBD) required Description TBD
TumorSecondaryDimensionSize optional The longest perpendicular diameter of the primary tumor.
SizeOfGrossTumorBed optional The largest dimension of the gross tumor bed/fibrotic area.
TumorMargins optional The edge or border of the tissue removed in cancer surgery. The margin is described as negative or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. The margin is described as positive or involved when the pathologist finds cancer cells at the edge of the tissue, suggesting that all of the cancer has not been removed.
Cellularity optional Percentage of cells in a sample that are cancerous
PercentageInSituCarcinoma optional The percentage of the cancer that is in situ, as opposed to invading other tissues.
SpecificType required A code or description representing the concept represented by the instance at a specific level. For example, for a Condition, the concept is MTH#C0348080 (Condition) but the Value is the SpecificType, i.e. MTH#C0011849 (Diabetes Mellitus). For an observation, the SpecificType defines what is being observed, measured, or asked, as specifically as possible. The SpecificType should always align with the concept of the element, for example, a blood pressure observation can be coded as a sitting blood pressure or standing blood pressure, and may be from a different code system (e.g. LOINC versus MTH). In other cases, the SpecificType is the specific question being asked, or the specific goal being pursued.
Category from ObservationCategoryVS (if covered) 0 or more A categorization of the action according its type, often a code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This can be used for searching, sorting and display purposes.
BodySite optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Reason optional The justification for an action or non-action, conclusion, opinion, etc.
AssociatedStudy optional The clinical trial or other formal study related to this finding.
Status must be from http://hl7.org/fhir/ValueSet/observation-status required The position of affairs at a particular time
Method optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
AssertionNegationModifier optional When true, this modifier indicates that the associated observation, assessment, or finding is false, the condition is absent. For example, if the assessment is 'allergy to peanuts' and the AssertionNegationModifier is true, it means the subject does not have an allergy to peanuts.
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.
DataAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
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).
ReferenceRange 0 or more The usual or acceptable range for a test result.
Interpretation optional A clinical interpretation of a measurement.
Comment optional A critical or explanatory note written to discuss, support, explain changes to, or dispute information.
PanelMembers optional PanelMembers represent the elements of a group of a related observations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent observation, but the grouping reflects a composite lab order, shared specimen, or a single report author.
NonOccurrenceModifier optional When true, indicates either that the event or action documented in the entry did not occur. For example, if immunization is not given, the NonOccurrenceModifier=true will indicate this. When applied to a recommendation, the modifier indicates the action mentioned in the topic should not take place. For example, a request to NOT elevate the head of a bed using the code for elevating the bed, and setting ProhibitedModifier to true. Other examples include do not ambulate, do not flush NG tube, do not take blood pressure on a certain arm, etc. If the SpecificType contains negation and ProhibitedModifier is true, that will reinforce the prohibition, and should not be interpreted as a double negative that equals a positive.
OccurrenceTime optional The point in time or span of time in which something happens.
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.