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Vital

The SHR Vital domain contains definitions for basic physiological measurements categorized as vital signs.

BloodPressure [Entry]

The force of circulating blood on the walls of the arteries. 55284-4

Based On VitalSign

Value:  Quantity A quantity with units.
BodySite must be from BloodPressureBodySiteVS optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
ObservationQualifier must be from BloodPressureQualifierVS 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.
SystolicPressure required The blood pressure during the contraction of the left ventricle of the heart, when blood pressure is at its highest.
DiastolicPressure required The blood pressure after the contraction of the heart while the chambers of the heart refill with blood, when the pressure is lowest.
HeadTiltAngle optional The angle at which the head is tilted relative to a level position while physiologic tests are taken.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
         where  TestMethod must be from BloodPressureMethodVS The technique used to carry out a procedure, if not implicit in the test code.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

BodyHeight [Entry]

The distance from the sole to the crown of the head. 8302-2

Based On VitalSign

Value:  Quantity Units is cm (cm) A quantity with units.
ObservationQualifier must be from BodyHeightQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

BodyLength [Entry]

The distance from the sole of the foot to the crown of the head, lying down (typically 0-2 years). 8306-3

Based On BodyHeight

Value:  Quantity Units is cm (cm) A quantity with units.
ObservationQualifier must be from BodyHeightQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

BodyMassIndex [Entry]

A general indicator of the body fat an individual is carrying based upon the ratio of weight to height. 39156-5

Based On VitalSign

Value:  Quantity A quantity with units.
BodyWeight optional The mass or quantity of heaviness of an individual. Does not include estimates of fetal bodyweight.
BodyHeight optional The distance from the sole to the crown of the head.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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).
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.

BodyTemperature [Entry]

The measure of the level of heat in a human or animal. 8310-5

Based On VitalSign

Value:  Quantity Units is C (Cel) A quantity with units.
BodySite must be from BodyTemperatureBodySiteVS optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
ObservationQualifier must be from BodyTemperatureQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

BodyWeight [Entry]

The mass or quantity of heaviness of an individual. Does not include estimates of fetal bodyweight. 29463-7

Based On VitalSign

Value:  Quantity Units is kg (kg) A quantity with units.
ObservationQualifier must be from BodyWeightQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

DiastolicPressure

The blood pressure after the contraction of the heart while the chambers of the heart refill with blood, when the pressure is lowest. 8462-4

Based On ObservationComponent

Value:  Quantity Units is mmHg (mm[Hg]) A quantity with units.
SpecificType is 8462-4 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.

HeadCircumference [Entry]

Circumference of the head (typically 0-2 years). 8287-5

Based On VitalSign

Value:  Quantity Units is cm (cm) A quantity with units.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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).
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.

HeadTiltAngle

The angle at which the head is tilted relative to a level position while physiologic tests are taken. 8360-0

Value:  Quantity Units is deg (deg) A quantity with units.

HeartRate [Entry]

The number of times the heart ventricles contract per unit of time, usually per minute. 8867-4

Based On VitalSign

Value:  Quantity Units is /min (/min) A quantity with units.
ObservationQualifier must be from HeartRateQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
         where  TestMethod must be from HeartRateMethodVS optional The technique used to carry out a procedure, if not implicit in the test code.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

OxygenSaturation [Entry]

Oxygen saturation in Arterial blood by Pulse oximetry. 59408-5

Based On VitalSign

Value:  Quantity Units is % (%) A quantity with units.
BodySite must be from OxygenSaturationBodySiteVS optional A location in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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).
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.

RespiratoryRate [Entry]

The rate of breathing (inhalation and exhalation) measured within in a unit time, expressed as breaths per minute. 9279-1

Based On VitalSign

Value:  Quantity Units is /min (/min) A quantity with units.
ObservationQualifier must be from RespiratoryRateQualifierVS 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.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
         where  TestMethod must be from RespiratoryRateMethodVS optional The technique used to carry out a procedure, if not implicit in the test code.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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.
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).
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.

SystolicPressure

The blood pressure during the contraction of the left ventricle of the heart, when blood pressure is at its highest. 8480-6

Based On ObservationComponent

Value:  Quantity Units is mmHg (mm[Hg]) A quantity with units.
SpecificType is 8480-6 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.

VitalSign

No Description Vital Sign (8716-3)

Based On Test

Value:  Quantity A quantity with units.
Category is vital-signs 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.
Specimen (TBD) not used Description TBD
SpecificType must be from http://hl7.org/fhir/ValueSet/observation-codes 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.
Method must be a TestMethod optional The method of the observation, for example, the specific imaging technical or assessment vehicle.
BodyPosition optional The position or physical attitude of the body.
Device optional A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange optional The usual or acceptable range for a test result.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
TestRequest optional A record of a request (order) for a test to be performed.
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).
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.